Healthcare Provider Details

I. General information

NPI: 1174708093
Provider Name (Legal Business Name): ASHLEY G EDWARDS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 07/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CHESTER AVE
BAKERSFIELD CA
93301-2014
US

IV. Provider business mailing address

222 POTAWATOMI ST
VENTURA CA
93001-0335
US

V. Phone/Fax

Practice location:
  • Phone: 661-395-3000
  • Fax: 239-261-4232
Mailing address:
  • Phone: 239-682-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberANT 9233897
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number547022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: