Healthcare Provider Details

I. General information

NPI: 1770127425
Provider Name (Legal Business Name): ASHLEY CAUSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHARLES AVE APT 2
SYRACUSE NY
13209-1608
US

IV. Provider business mailing address

120 CHARLES AVE APT 2
SYRACUSE NY
13209-1608
US

V. Phone/Fax

Practice location:
  • Phone: 315-965-6835
  • Fax:
Mailing address:
  • Phone: 315-965-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number757264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: