Provider Demographics
NPI:1568929941
Name:MAGNUSON, ASHLEY ELIZABETH (PCA, CST)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:PCA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 TRAILWOOD S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3930
Mailing Address - Country:US
Mailing Address - Phone:763-232-5919
Mailing Address - Fax:
Practice Address - Street 1:1211 TRAILWOOD S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3930
Practice Address - Country:US
Practice Address - Phone:763-232-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPCA74747420190221374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide