Healthcare Provider Details

I. General information

NPI: 1225745821
Provider Name (Legal Business Name): ASHLEY NICOLE WAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE KUWIK RN

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

5733 HAMLET RD
VIRGINIA BEACH VA
23464-2211
US

V. Phone/Fax

Practice location:
  • Phone: 757-576-0415
  • Fax:
Mailing address:
  • Phone: 757-576-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1229957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: