=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336396688
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY NORELL BARTZ RPA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2008
-----------------------------------------------------
Last Update Date | 11/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2646 WEST STATE STREET SUITE 405
-----------------------------------------------------
City | OLEAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-373-8870
-----------------------------------------------------
Fax | 716-373-8871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2646 W STATE ST SUITE 405
-----------------------------------------------------
City | OLEAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14760-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-373-8870
-----------------------------------------------------
Fax | 716-373-8871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 012654
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------