Provider Demographics
NPI:1437411634
Name:ANTROBUS, ASHLEY ANN (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:ANTROBUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35A MARCH CT
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2032
Mailing Address - Country:US
Mailing Address - Phone:631-764-5165
Mailing Address - Fax:
Practice Address - Street 1:35A MARCH CT
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2032
Practice Address - Country:US
Practice Address - Phone:631-764-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY636918-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY636918-1Medicaid