=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063133114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEE MCILRATH CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2022
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1815 W 13TH ST STE 1
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-652-4705
-----------------------------------------------------
Fax | 302-652-2917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1815 W 13TH ST STE 1
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-652-4705
-----------------------------------------------------
Fax | 302-652-2917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP026143
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------