Provider Demographics
NPI:1144325648
Name:AMBROSY, NAN L (DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:L
Last Name:AMBROSY
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:DR
Other - First Name:NAN
Other - Middle Name:
Other - Last Name:AMBROSY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, ARNP
Mailing Address - Street 1:2750 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5644
Mailing Address - Country:US
Mailing Address - Phone:319-272-8922
Mailing Address - Fax:319-272-8929
Practice Address - Street 1:2750 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5644
Practice Address - Country:US
Practice Address - Phone:319-272-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74864363LP0808X
KS53-45383364SP0808X
IAT128919364SP0809X
IAG128919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0704914Medicaid
KS100450710CMedicaid
KS161308OtherBLUE CROSS AND BLUE SHIEL
IA0704914Medicaid