Healthcare Provider Details

I. General information

NPI: 1598020182
Provider Name (Legal Business Name): ASHLEY E DEITERING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S MAIN ST
FINDLAY OH
45840-1214
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-4500
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: