Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP008686 | PA |
NPI | 1023194024 |
---|---|
Provider Name | Michele Ann Ambrosino |
First Address | Greenwich, NJ 08323 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |