Provider Demographics
NPI:1417303678
Name:MOAN, ASHLEY DEAN (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEAN
Last Name:MOAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DEAN
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1080 FIRST COLONIAL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2406
Mailing Address - Country:US
Mailing Address - Phone:757-481-7222
Mailing Address - Fax:757-390-2935
Practice Address - Street 1:1080 FIRST COLONIAL RD
Practice Address - Street 2:STE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-481-7222
Practice Address - Fax:757-390-2935
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172447363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health