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Maria Ambush

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7900 W Jefferson Blvd Ste 104, Fort Wayne, IN 46804-4128

PECOS Enrollment

Based on the most recent information from CMS, provider Maria Ambush is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1083123103
Provider Type
Individual
Full Name
Ambush, Maria
Title
Mrs.
Credential
NP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/20/2017
Last Updated
9/20/2017

Contact Information

Practice Location

7900 W Jefferson Blvd Ste 104, Fort Wayne, IN 46804-4128

(260) 435-7350

Unlisted Fax

Mailing Location

11825 Keepers Gate, Spencerville, IN 46788-9289

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 71007511A Indiana

Maria Ambush

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Hoover, Kara Rae

Shively, Gail L

Stanley, Lisa R.

Dantzer, Brandy M.

Riddle, Robin Lee Ann

Allen County Wellness Center Llc

Hufford, Theresa

Lee, Ford W.

Staddon, Dana L

Rodriguez, Laura L