Individual ProviderNathan AmbrosePhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address200 NE Mother Joseph Pl Ste 110, Vancouver, WA 98664-3293(360) 254-6161PECOS EnrollmentBased on the most recent information from CMS, provider Nathan Ambrose is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1285229500Provider TypeIndividualFull NameAmbrose, NathanCredentialPA-CGenderMaleSole ProprietorNoEnumeration Date3/8/2021Last Updated10/30/2024Contact InformationPractice LocationPractice Address200 NE Mother Joseph Pl Ste 110, Vancouver, WA 98664-3293Phone(360) 254-6161Fax(360) 803-0847Mailing LocationMailing Address200 NE Mother Joseph Pl Ste 210, Vancouver, WA 98664-3295Phone(360) 254-6161Fax(360) 803-0847Provider TaxonomiesCodeDescriptionLicenseCode363AS0400XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA61409222WashingtonCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA208018Oregon