Healthcare Provider Details

I. General information

NPI: 1528682663
Provider Name (Legal Business Name): ASHLEY NICOLE DENBROCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE WOLCOTT

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

6210 GIBSON LN APT 7205
TEXARKANA TX
75503-1260
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax:
Mailing address:
  • Phone: 517-937-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704314170
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: