=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144082256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLYN MARIE KRANTZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2024
-----------------------------------------------------
Last Update Date | 01/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2137 ALPINE GLEN PL
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91901-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-820-2523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2137 ALPINE GLEN PL
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91901-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WR1000X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology/Infertility Registered Nurse
-----------------------------------------------------
License Number | 95259380
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------