Healthcare Provider Details

I. General information

NPI: 1215485339
Provider Name (Legal Business Name): ASHLEY MCDERMID CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY GILMORE CST

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 BRAMBLE DR
RENO NV
89509-6901
US

IV. Provider business mailing address

3042 BRAMBLE DR
RENO NV
89509-6901
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-0313
  • Fax: 951-587-8277
Mailing address:
  • Phone: 775-544-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: