Provider Demographics
NPI:1659052488
Name:MCQUAID, ASHLYNN WILLOW
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:WILLOW
Last Name:MCQUAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:FELTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 E THOMSON AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3900
Mailing Address - Country:US
Mailing Address - Phone:707-721-2051
Mailing Address - Fax:
Practice Address - Street 1:1221 N DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4607
Practice Address - Country:US
Practice Address - Phone:707-543-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19774171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist