Healthcare Provider Details

I. General information

NPI: 1407341407
Provider Name (Legal Business Name): ASHLEY NICOLE CONNELLY CRNA, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE MARTINEZ

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/26/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

3 LYNN DR
NEWARK DE
19711-7029
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 410-441-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118616
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00800
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: