1174866057 NPI number — SARAH JANE AMBROSE CPM

Table of content: SARAH JANE AMBROSE CPM (NPI 1174866057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174866057 NPI number — SARAH JANE AMBROSE CPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBROSE
Provider First Name:
SARAH
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174866057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3876 BRIDGE WAY N
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-624-6627
Provider Business Mailing Address Fax Number:
206-525-5933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3876 BRIDGE WAY N
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-6627
Provider Business Practice Location Address Fax Number:
206-525-5933
Provider Enumeration Date:
03/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  MW 60295161 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)