Provider Demographics
NPI:1033820352
Name:VANNATTER, ASHLEY DAWN (PRSS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:VANNATTER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DAWN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PRSS
Mailing Address - Street 1:3825 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1725
Mailing Address - Country:US
Mailing Address - Phone:681-294-4326
Mailing Address - Fax:681-378-6108
Practice Address - Street 1:1236 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2207
Practice Address - Country:US
Practice Address - Phone:681-294-4326
Practice Address - Fax:681-378-6108
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000000175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist