Healthcare Provider Details

I. General information

NPI: 1700458346
Provider Name (Legal Business Name): ASHLEY ALEX CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326
US

IV. Provider business mailing address

29 RONNIE CT
SCHENECTADY NY
12306-2555
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number710684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: