Provider Demographics
NPI:1225565161
Name:SMACK, ASHLEY ELISE (EMT-B)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELISE
Last Name:SMACK
Suffix:
Gender:F
Credentials:EMT-B
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:ELISE
Other - Last Name:STINGER-DRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT-B
Mailing Address - Street 1:9040 JACKSON AVENUE
Mailing Address - Street 2:ATTN: MCHJ-CLQ-C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E3022364146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic