Provider Demographics
NPI:1225814288
Name:BOUSQUET, ASHLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:CEPHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11260 DONNER PASS RD STE C1-459
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4848
Mailing Address - Country:US
Mailing Address - Phone:310-525-0507
Mailing Address - Fax:
Practice Address - Street 1:11260 DONNER PASS RD STE C1-459
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4848
Practice Address - Country:US
Practice Address - Phone:310-525-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95108000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse