Healthcare Provider Details

I. General information

NPI: 1174915599
Provider Name (Legal Business Name): MS. ASHLYN RENEE ALBRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2015
Last Update Date: 02/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

7017 THORNAPPLE RIVER DR SE
CALEDONIA MI
49316-8307
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax:
Mailing address:
  • Phone: 616-340-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA416072734270
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: