Healthcare Provider Details

I. General information

NPI: 1194359562
Provider Name (Legal Business Name): NICHOL ASHMORE APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 4TH AVE
MOLINE IL
61265-1231
US

IV. Provider business mailing address

310 W 16TH AVE
COAL VALLEY IL
61240-9358
US

V. Phone/Fax

Practice location:
  • Phone: 563-336-3000
  • Fax: 563-327-2045
Mailing address:
  • Phone: 309-269-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020843
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA161611
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: