Healthcare Provider Details

I. General information

NPI: 1679807978
Provider Name (Legal Business Name): ANNIE BELL ASHLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 N SHERMAN BLVD
MILWAUKEE WI
53210-2947
US

IV. Provider business mailing address

2421 N SHERMAN BLVD
MILWAUKEE WI
53210-2947
US

V. Phone/Fax

Practice location:
  • Phone: 414-306-2450
  • Fax:
Mailing address:
  • Phone: 414-306-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number163124-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: