Healthcare Provider Details

I. General information

NPI: 1346892502
Provider Name (Legal Business Name): JEFFERY ALLEN ASH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

IV. Provider business mailing address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5700
  • Fax:
Mailing address:
  • Phone: 810-985-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704222855NSA190JI
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: