Healthcare Provider Details

I. General information

NPI: 1689283434
Provider Name (Legal Business Name): ASHLEY KOCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARIE KIRSCH RN

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 DETROIT AVE STE 620
LAKEWOOD OH
44107-4180
US

IV. Provider business mailing address

38882 MENTOR AVE
WILLOUGHBY OH
44094-7875
US

V. Phone/Fax

Practice location:
  • Phone: 216-766-6080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number395443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: