Healthcare Provider Details

I. General information

NPI: 1780130823
Provider Name (Legal Business Name): ASHLYN WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 LONE PINE BLVD
THE DALLES OR
97058-9403
US

IV. Provider business mailing address

551 LONE PINE BLVD
THE DALLES OR
97058-9403
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA177141
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: