Healthcare Provider Details

I. General information

NPI: 1609837244
Provider Name (Legal Business Name): ASHLEY ELIZABETH ASHWILL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. ASHLEY ELIZABETH VILLNOW

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 S PEORIA AVE
TULSA OK
74120-4495
US

IV. Provider business mailing address

5780 S PEORIA AVE PPAEO INC
TULSA OK
74105-7857
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-1101
  • Fax:
Mailing address:
  • Phone: 918-858-5200
  • Fax: 918-582-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL0040414
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: