Healthcare Provider Details

I. General information

NPI: 1376222620
Provider Name (Legal Business Name): ASHLEY DALGARNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

167 TIMBERWOOD DR
CASTLE ROCK WA
98611-9126
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2385
  • Fax: 360-414-2386
Mailing address:
  • Phone: 360-957-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61238293
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: