Healthcare Provider Details

I. General information

NPI: 1982869715
Provider Name (Legal Business Name): RALPH KENNETH ABLASEAU NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIRCLE SUITE 105
WILLIAMSBURG VA
23185-5629
US

IV. Provider business mailing address

PO BOX 1239
TROY MI
48099-1239
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax: 757-564-0557
Mailing address:
  • Phone: 248-824-6600
  • Fax: 248-324-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164829
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024164829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: