Provider Demographics
NPI:1467800631
Name:MUNCY, ASHLEE DAWN
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:DAWN
Last Name:MUNCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 GLADSTONE ST APT D
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5070
Mailing Address - Country:US
Mailing Address - Phone:505-399-1433
Mailing Address - Fax:
Practice Address - Street 1:2112 GLADSTONE ST APT D
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5070
Practice Address - Country:US
Practice Address - Phone:505-399-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other