1740520758 NPI number — MISS RONNETTE ROCHELLE ASHLEY

Table of content: MISS RONNETTE ROCHELLE ASHLEY (NPI 1740520758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740520758 NPI number — MISS RONNETTE ROCHELLE ASHLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHLEY
Provider First Name:
RONNETTE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
RONNETTE
Provider Other Middle Name:
ROCHELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740520758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
492 SPEARMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28423-8622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-655-9827
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 SPEARMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28423-8622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-655-9827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2013

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: 311ZA0620X , with the licence number:  FCL024014 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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