Provider Demographics
NPI:1053522441
Name:NAN L. AMBROSY, ARNP, PA
Entity type:Organization
Organization Name:NAN L. AMBROSY, ARNP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-539-9990
Mailing Address - Street 1:1213 HYLTON HEIGHTS RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2810
Mailing Address - Country:US
Mailing Address - Phone:785-539-9990
Mailing Address - Fax:785-539-9998
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2810
Practice Address - Country:US
Practice Address - Phone:785-539-9990
Practice Address - Fax:785-539-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74864363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160992OtherBLUE CROSS & BLUE SHIELD
KS160992Medicare ID - Type Unspecified