Healthcare Provider Details

I. General information

NPI: 1699510792
Provider Name (Legal Business Name): ASHLEY PURUGGANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LOMBARD ST
BALTIMORE MD
21201-1512
US

IV. Provider business mailing address

400 W FAYETTE ST APT 812
BALTIMORE MD
21201-2273
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-0501
  • Fax:
Mailing address:
  • Phone: 571-209-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN500003114
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR254851
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: