Healthcare Provider Details

I. General information

NPI: 1336396688
Provider Name (Legal Business Name): ASHLEY NORELL BARTZ RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 WEST STATE STREET SUITE 405
OLEAN NY
14760
US

IV. Provider business mailing address

2646 W STATE ST SUITE 405
OLEAN NY
14760-1866
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-8870
  • Fax: 716-373-8871
Mailing address:
  • Phone: 716-373-8870
  • Fax: 716-373-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: