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General NPI Number Information
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NPI Number | 1295296697
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Entity Type | Individual
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Provider Name | ASHLYN CLAY DIFREDERICO NP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 30 E APPLE ST STE 6252
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City | DAYTON
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State | OH
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Zip | 45409-2939
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Country | US
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Telephone | 937-208-6730
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Fax | 770-420-3422
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Provider Business Mailing Address
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Address Line | 30 E APPLE ST STE 6252
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City | DAYTON
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State | OH
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Zip | 45409-2939
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Country | US
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Telephone | 937-208-6730
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Fax | 770-420-3422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN267756
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0036367
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License Number State | OH
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