1134621345 NPI number — ASHLEY NICOLE SCHALK APRN, RN

Table of content: ASHLEY NICOLE SCHALK APRN, RN (NPI 1134621345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134621345 NPI number — ASHLEY NICOLE SCHALK APRN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHALK
Provider First Name:
ASHLEY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BODDY
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134621345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23720 OTTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BOSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48164-9663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-934-7448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9870 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-291-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  53-78027-092 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 4704398355 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)