Healthcare Provider Details

I. General information

NPI: 1558814780
Provider Name (Legal Business Name): ASHLEY STEVENSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 07/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W CENTER ST #208
ROCHESTER MN
55902-6278
US

IV. Provider business mailing address

1102 3RD ST SE
KASSON MN
55944-1698
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-0436
  • Fax:
Mailing address:
  • Phone: 507-259-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8491
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: