Provider Demographics
NPI:1609410976
Name:DECRAENE, ASHLEY N (NP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:DECRAENE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W UNIVERSITY DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1875
Mailing Address - Country:US
Mailing Address - Phone:248-375-4033
Mailing Address - Fax:483-754-0342
Practice Address - Street 1:1000 W UNIVERSITY DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1875
Practice Address - Country:US
Practice Address - Phone:248-375-4033
Practice Address - Fax:483-754-0342
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704290238OtherMI NP LICENSE