Provider Demographics
NPI:1093573230
Name:NELSON, ASHLEY LEA MAE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEA MAE
Last Name:NELSON
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 1:210 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:ND
Mailing Address - Zip Code:58064-4118
Mailing Address - Country:US
Mailing Address - Phone:701-429-8229
Mailing Address - Fax:
Practice Address - Street 1:210 2ND ST
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:ND
Practice Address - Zip Code:58064-4118
Practice Address - Country:US
Practice Address - Phone:701-429-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty