Healthcare Provider Details

I. General information

NPI: 1144791310
Provider Name (Legal Business Name): SHARLEE ASHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LA JARA ST
BLOOMFIELD NM
87413-6626
US

IV. Provider business mailing address

310 LA JARA ST
BLOOMFIELD NM
87413-6626
US

V. Phone/Fax

Practice location:
  • Phone: 505-634-3891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-86089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: