Provider Demographics
NPI:1093451387
Name:CLARKE, ASHLEY MARIE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2867
Mailing Address - Country:US
Mailing Address - Phone:631-406-3871
Mailing Address - Fax:
Practice Address - Street 1:9 MELISSA DR
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2867
Practice Address - Country:US
Practice Address - Phone:631-406-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344521164W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No164W00000XNursing Service ProvidersLicensed Practical Nurse