Healthcare Provider Details

I. General information

NPI: 1902224249
Provider Name (Legal Business Name): MS. ASHLEY PENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 11/11/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST SUITE 18-200
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

925 CHESTNUT STREET MEZZANINE
PHILADELPHIA PA
19107-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8630
  • Fax:
Mailing address:
  • Phone: 215-955-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD475104
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: