Basic Information
| Provider Information | |||||||||
| NPI: | 1669935151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMBUEHL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5108 BRITTANY DR | ||||||||
| Address2: | |||||||||
| City: | OLD HICKORY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371381250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155795836 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE STE 330 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152694545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2019 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN0000024260 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.