Healthcare Provider Details

I. General information

NPI: 1629948468
Provider Name (Legal Business Name): MS. ASHLEIGH MAE DUREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17442 PARKWOOD UNIT B
SPRING LAKE MI
49456-9455
US

IV. Provider business mailing address

17442 PARKWOOD UNIT B
SPRING LAKE MI
49456-9455
US

V. Phone/Fax

Practice location:
  • Phone: 231-740-7708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704376296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: