Provider Demographics
NPI:1497356125
Name:BLACKBIRD, ASHLEEN LEE (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEEN
Middle Name:LEE
Last Name:BLACKBIRD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLEEN
Other - Middle Name:LEE
Other - Last Name:MARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:ROSALIE
Mailing Address - State:NE
Mailing Address - Zip Code:68055-0213
Mailing Address - Country:US
Mailing Address - Phone:712-635-0254
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-3023
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-5303
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113347363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care