Healthcare Provider Details

I. General information

NPI: 1609750959
Provider Name (Legal Business Name): ASHLEY AHUMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 S PULASKI RD APT 113
OAK LAWN IL
60453-3398
US

IV. Provider business mailing address

9820 S PULASKI RD APT 113
OAK LAWN IL
60453-3398
US

V. Phone/Fax

Practice location:
  • Phone: 708-595-6741
  • Fax:
Mailing address:
  • Phone: 708-595-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041513760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: