Provider Demographics
NPI:1407405483
Name:MALEPORT, ASHLEY FAREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FAREN
Last Name:MALEPORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9760 BIRMINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8559
Mailing Address - Country:US
Mailing Address - Phone:989-350-8989
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1259
Practice Address - Country:US
Practice Address - Phone:248-348-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily