Provider Demographics
NPI:1003248600
Name:MCINNIS, ASHLEY RENEE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RENEE
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GARNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7243
Mailing Address - Country:US
Mailing Address - Phone:508-746-5900
Mailing Address - Fax:508-747-2290
Practice Address - Street 1:148 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-746-5900
Practice Address - Fax:508-747-2290
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270212363LP0200X, 163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner