NPI Code Detail JSON Logo

1841073822 NPI number — ASHLEY MONTAG WALLACE CRNA

NPI Number: 1841073822
Health Care Provider/Practitioner: ASHLEY MONTAG WALLACE CRNA

Information about “1841073822” NPI (ASHLEY MONTAG WALLACE CRNA) exists in 1841073822 in HTML format HTML  |  1841073822 in plain Text format TXT  |  1841073822 in PDF (Portable Document Format) PDF  |  1841073822 in an XML format XML  formats.

NPI Number : 1841073822 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841073822",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLACE",
    "FirstName": "ASHLEY",
    "MiddleName": "MONTAG",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MONTAG",
    "OtherFirstName": "ASHLEY",
    "OtherMiddleName": "MARGUERITE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5239 QUAIL FOREST DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEMMONS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27012-9984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-820-9919",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3333 SILAS CREEK PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WINSTON SALEM",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27103-3013",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-718-5000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/15/2023",
    "LastUpdateDate": "10/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "7981",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "155542",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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