Healthcare Provider Details

I. General information

NPI: 1740821578
Provider Name (Legal Business Name): ASHLEY HARRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 PRE EMPTION RD
GENEVA NY
14456-2069
US

IV. Provider business mailing address

1270 LEET RD
GENEVA NY
14456-9104
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-0993
  • Fax:
Mailing address:
  • Phone: 315-719-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: