Provider Demographics
NPI:1376194597
Name:IMBRUNNONE, ASHLEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:IMBRUNNONE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27302 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2743
Mailing Address - Country:US
Mailing Address - Phone:586-943-1891
Mailing Address - Fax:
Practice Address - Street 1:20952 E 12 MILE RD # 101
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3200
Practice Address - Country:US
Practice Address - Phone:586-498-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19183080727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily