Healthcare Provider Details

I. General information

NPI: 1730505694
Provider Name (Legal Business Name): ASHLEY ELIZABETH HEAD WHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY ELIZABETH PLONK RN

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 NEW BERN AVE SUITE 306
RALEIGH NC
27610-1247
US

IV. Provider business mailing address

2418 PRESTON GROVE AVE
CARY NC
27513-8405
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8535
  • Fax:
Mailing address:
  • Phone: 704-995-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233437
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5006796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: