Healthcare Provider Details

I. General information

NPI: 1891400487
Provider Name (Legal Business Name): ASHLYNN ELIZABETH FAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ELTON HILLS LN NW
ROCHESTER MN
55901-3577
US

IV. Provider business mailing address

470 CHRISTINA CT
ZUMBRO FALLS MN
55991-1932
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-1009
  • Fax:
Mailing address:
  • Phone: 507-251-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: