1922456839 NPI number — ASHLEY BENNETT WENCE APRN

Table of content: ASHLEY BENNETT WENCE APRN (NPI 1922456839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922456839 NPI number — ASHLEY BENNETT WENCE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENCE
Provider First Name:
ASHLEY
Provider Middle Name:
BENNETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNETT
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922456839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-295-2131
Provider Business Mailing Address Fax Number:
864-269-8039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 BEAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-295-2131
Provider Business Practice Location Address Fax Number:
864-269-8035
Provider Enumeration Date:
06/01/2016

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: 163W00000X , with the licence number:  216207 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 20318 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP3983 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01772172 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".