Healthcare Provider Details

I. General information

NPI: 1790593325
Provider Name (Legal Business Name): ASHLEY HENDERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

10777 NORTH RD
ELBERFELD IN
47613-9111
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax:
Mailing address:
  • Phone: 956-477-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153501
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: