Healthcare Provider Details

I. General information

NPI: 1205101391
Provider Name (Legal Business Name): MONA-LISA ASHBY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONA-LISA COLEMAN RN

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7508 BAYLOR WAY CT
CHARLOTTE NC
28215-6708
US

IV. Provider business mailing address

7508 BAYLOR WAY CT
CHARLOTTE NC
28215-6708
US

V. Phone/Fax

Practice location:
  • Phone: 704-208-7284
  • Fax: 980-226-5341
Mailing address:
  • Phone: 704-208-7284
  • Fax: 980-226-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number154238
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: