Healthcare Provider Details

I. General information

NPI: 1013499953
Provider Name (Legal Business Name): ASHLEY SUZETTE STONEROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY SUZETTE KRAMER

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

IV. Provider business mailing address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

V. Phone/Fax

Practice location:
  • Phone: 937-417-3093
  • Fax:
Mailing address:
  • Phone: 937-417-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberRA.161817
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: