MEDICARE: ASHLEY SOUDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R51326	ND
2	367500000X	Certified Registered Nurse Anesthetist	10032561	OR

General Provider Information

NPI Number	:	1063199479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SOUDERS

Provider Business Mailing Address
First Line	:	734 GREAT PLAINS CT
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7248
Country	:	US
Telephone Number	:	727-459-8625
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 OXFORD ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58202-6092
Country	:	US
Telephone Number	:	701-777-4174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	01/24/2025

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Directions to “ ASHLEY SOUDERS ” Practice Location

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