Provider Demographics
NPI:1417009093
Name:ASHBURN, NANCY M (MED)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5055
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-5055
Mailing Address - Country:US
Mailing Address - Phone:509-447-5651
Mailing Address - Fax:509-447-2671
Practice Address - Street 1:105 SOUTH GARDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-5055
Practice Address - Country:US
Practice Address - Phone:509-447-5651
Practice Address - Fax:509-447-2671
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60306312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health