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General NPI Number Information
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NPI Number | 1790087542
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Entity Type | Individual
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Provider Name | ASHLEY MAE PEDERSON CNP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 40W821 DENNY RD
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City | SUGAR GROVE
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State | IL
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Zip | 60554-5922
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Country | US
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Telephone | 859-750-6997
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Fax |
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 209012632
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License Number State | IL
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