Provider Demographics
NPI:1225421373
Name:KLISZ, ASHLEY JEANELL (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEANELL
Last Name:KLISZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26400 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1700
Mailing Address - Country:US
Mailing Address - Phone:248-208-8787
Mailing Address - Fax:888-821-9112
Practice Address - Street 1:26400 W 12 MILE RD STE 170
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1753
Practice Address - Country:US
Practice Address - Phone:248-208-8787
Practice Address - Fax:888-821-9112
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704257177363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care