Healthcare Provider Details

I. General information

NPI: 1134621345
Provider Name (Legal Business Name): ASHLEY NICOLE SCHALK APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE BODDY RN

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9870 TELEGRAPH RD
TAYLOR MI
48180-3399
US

IV. Provider business mailing address

23720 OTTER RD
NEW BOSTON MI
48164-9663
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-6600
  • Fax:
Mailing address:
  • Phone: 734-934-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78027-092
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704398355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: