Healthcare Provider Details

I. General information

NPI: 1750750097
Provider Name (Legal Business Name): ASHLEY ELIZABETH MEDLEY CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

IV. Provider business mailing address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

V. Phone/Fax

Practice location:
  • Phone: 804-363-1230
  • Fax:
Mailing address:
  • Phone: 804-363-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number16.000509
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104601428
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: