Healthcare Provider Details

I. General information

NPI: 1417200098
Provider Name (Legal Business Name): ASHLEY N FIDLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S 21ST ST
EASTON PA
18042-3851
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 610-250-4303
  • Fax: 610-250-4804
Mailing address:
  • Phone: 888-709-4485
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704255805
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR14352600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number615936-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN604134
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: