Healthcare Provider Details

I. General information

NPI: 1154829687
Provider Name (Legal Business Name): ASHLEY NICOLE HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409
US

IV. Provider business mailing address

2952 OAKLAND AVE
KETTERING OH
45409-1653
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number019638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: