JACQUELINE EBONY AMBUSH (NPI# 1013335546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013335546 |
| Entity Type | Individual |
| Full Name | JACQUELINE EBONY AMBUSH |
| Credential | PNP BC |
| Practice Address |
4367 Hollins Ferry Rd Ste.1c Baltimore MD 21227-3400 |
| Mailing Address |
4367 Hollins Ferry Rd Ste 1c Baltimore MD 21227-3400 |
| Practice Telephone | 4107075947 |
| Mailing Telephone | 4107075947 |
| Mailing Fax Number | 4106096672 |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2015-06-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
R117755 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
R117755 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | MARYLAND BOARD OF NURSING | R117755 | 01 |
| Street Address |
4367 HOLLINS FERRY RD STE.1C |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21227-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437167368 | Geetha Raja | Internal Medicine | 4367 Hollins Ferry Rd, Suite 4a, Baltimore, MD 21227 | 2006-08-04 |
| 1346646379 | Halethorpe Orthodontics, LLC | Dentist | 4367 Hollins Ferry Rd, Suite 1d, Baltimore, MD 21227-3400 | 2014-11-19 |
| 1538312194 | Dr. Darlyne Cange, Dpm, LLC | Podiatrist | 4367 Hollins Ferry Rd, Suite 4a, Baltimore, MD 21227-3400 | 2008-10-28 |
| 1316160716 | Henry Honick IIi | Dentist | 4367 Hollins Ferry Rd, Suite 4c, Baltimore, MD 21227-3400 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528622024 | Kim Conaway | Counselor | Regenerations Counseling Services, 1421 S. Canton Street, Baltimore, MD 21227 | 2019-04-30 |
| 1861974891 | Joan Lynn Indilisano | Occupational Therapist | 3320 Benson Avenue, Baltimore, MD 21227 | 2018-09-06 |
| 1821593161 | Institute for Dermatopathology, Inc. | Clinical Medical Laboratory | 1901 Sulphur Spring Rd Ste A, Baltimore, MD 21227 | 2018-03-28 |
| 1447779699 | Aja Williams | Registered Nurse | 3902 Annapolis Rd., Halethorpe, MD 21227 | 2017-09-19 |
| 1588190748 | Mentor-maryland | Community/Behavioral Health | 1540 Caton Center Drive, Halethorpe, MD 21227 | 2017-05-10 |
| 1083084180 | Institute for Family Centered Services | Community/Behavioral Health | 1540 Caton Centered Drive, Suite F, Baltimore, MD 21227 | 2015-10-01 |
| 1174913677 | Wye Oak Clinic, Inc. | Marriage & Family Therapist | 1937 Lansdowne Rd, Halethorpe, MD 21227 | 2015-02-04 |
| 1588938237 | Ahmein Watson | Social Worker | 1504 Joh Ave Ste 120, Baltimore, MD 21227 | 2012-02-28 |
| 1336442656 | Norah Orise Osian | Pharmacist | Rite Aid Pharmacy, 1400 Sulphur Spring Rd, Baltimore, MD 21227 | 2010-12-08 |
| 1366759623 | Een J Lee | Pharmacist | 1400 Sulphurspring Rd, Baltimore, MD 21227 | 2010-09-08 |
| Find all providers in zip 21227 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420282 | Mary Claire Perry | Nurse Practitioner | 737 W Lombard St Ste 314, Baltimore, MD 21201-1009 | 2020-09-03 |
| 1629563879 | Ashley C Sayles | Nurse Practitioner | 5601 Loch Raven Blvd Ste 200, Baltimore, MD 21239 | 2018-06-28 |
| 1396237673 | Kinderhealth, LLC | Nurse Practitioner | 10 W West St, Baltimore, MD 21230 | 2018-06-03 |
| 1306378120 | Teddi Roseman | Nurse Practitioner | 22 S Greene St Rm N5e16, Baltimore, MD 21201-1544 | 2017-03-30 |
| 1295280873 | Sarah Schlotterbeck Perl | Nurse Practitioner | 6711 Evanston Rd, Baltimore, MD 21209-3865 | 2016-08-24 |
| 1710333448 | Rachel Levy | Nurse Practitioner | 7010 Wallis Ave, Baltimore, MD 21215-1711 | 2016-05-12 |
| 1427425875 | Bernadette Russell | Nurse Practitioner | 1213 Harbor Island Walk, Baltimore, MD 21230-5461 | 2015-09-01 |
| 1750766879 | Laura Gertz | Nurse Practitioner | 1400 Orleans St, Baltimore, MD 21231-1021 | 2015-07-30 |
| 1336520402 | Clifton Peter Thornton | Nurse Practitioner | 1800 Orleans St Rm 11356, Baltimore, MD 21287-0010 | 2015-06-15 |
| 1295131332 | Erin Sherman | Nurse Practitioner | 306 Murdock Rd, Baltimore, MD 21212-1825 | 2014-11-18 |
| Find all providers in BALTIMORE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.