Healthcare Provider Details

I. General information

NPI: 1942452511
Provider Name (Legal Business Name): ASHLEY E. SCHAEFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date: 07/21/2021
Reactivation Date: 08/06/2021

III. Provider practice location address

950 MAIN ST CLARK UNIVERSITY HEALTH SERVICES
WORCESTER MA
01610-1400
US

IV. Provider business mailing address

950 MAIN ST
WORCESTER MA
01610-1400
US

V. Phone/Fax

Practice location:
  • Phone: 508-793-7467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number266774
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003963
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003963
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0719625
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: