Healthcare Provider Details

I. General information

NPI: 1205364973
Provider Name (Legal Business Name): MS. ASHLEY NICOLE TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1708
US

IV. Provider business mailing address

1245 ONSLOW DR
COLUMBUS OH
43204-4720
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-8131
  • Fax: 614-827-8380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number148126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: