Provider Demographics
NPI:1568754000
Name:GUENIN, ASHLEIGH B (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:B
Last Name:GUENIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:B
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:ONE MEMORIAL SQUARE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1270
Mailing Address - Country:US
Mailing Address - Phone:317-468-6257
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:124 W. MUSKEGON DRIVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3069
Practice Address - Country:US
Practice Address - Phone:317-468-4357
Practice Address - Fax:317-468-4580
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167176A363LA2100X
IN71003342A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026190Medicaid
INMR2226339Medicare PIN
IN136310002Medicare PIN