Healthcare Provider Details

I. General information

NPI: 1255983136
Provider Name (Legal Business Name): ASHLEY PERKINS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE # MC191
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

6876 GETTYSBURG DR
HUDSONVILLE MI
49426-9336
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-0095
  • Fax:
Mailing address:
  • Phone: 616-551-6854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704285072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: