Provider Demographics
NPI:1174269666
Name:DIECK, ASHLEY PERRONNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PERRONNE
Last Name:DIECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5476
Mailing Address - Country:US
Mailing Address - Phone:985-788-5682
Mailing Address - Fax:
Practice Address - Street 1:333 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2739
Practice Address - Country:US
Practice Address - Phone:985-641-5914
Practice Address - Fax:985-641-6397
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA137073163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool