1831164532 NPI number — MISS NANDA N AMBORE OTR,CLT-LANA

Table of content: MISS NANDA N AMBORE OTR,CLT-LANA (NPI 1831164532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831164532 NPI number — MISS NANDA N AMBORE OTR,CLT-LANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBORE
Provider First Name:
NANDA
Provider Middle Name:
N
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTR,CLT-LANA
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:
1831164532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2611 SUNBURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-689-2061
Provider Business Mailing Address Fax Number:
432-689-2157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 ANDREWS HWY #439
Provider Second Line Business Practice Location Address:
MIDLAND WESTERN BUILDING
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-689-2061
Provider Business Practice Location Address Fax Number:
432-689-2157
Provider Enumeration Date:
02/17/2006

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: 225X00000X , with the licence number:  106765 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 170848901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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