Healthcare Provider Details

I. General information

NPI: 1679872360
Provider Name (Legal Business Name): ASHLEY VIOLET PRESLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY VIOLET GRENNELL LPN

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19444 SHADLEY VALLEY RD
DANVILLE OH
43014-9500
US

IV. Provider business mailing address

19444 SHADLEY VALLEY RD
DANVILLE OH
43014-9500
US

V. Phone/Fax

Practice location:
  • Phone: 740-398-1575
  • Fax:
Mailing address:
  • Phone: 740-398-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 137295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: