Provider Demographics
NPI:1063006377
Name:MUNROE, ASHLEY WELLS (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:WELLS
Last Name:MUNROE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MEDFORD ST APT 212
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1989
Mailing Address - Country:US
Mailing Address - Phone:781-591-9311
Mailing Address - Fax:
Practice Address - Street 1:MGH- DEPT OF EMERGENCY MEDICINE
Practice Address - Street 2:55 FRUIT ST, AUSTEN 110
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:781-591-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304247163W00000X
MAPA8299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2304247Medicaid