Provider Demographics
NPI:1659833986
Name:CULVER, ASHLEE LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:LAUREN
Last Name:CULVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:LAUREN
Other - Last Name:TISDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2233 W KAGY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5938
Mailing Address - Country:US
Mailing Address - Phone:406-586-7873
Mailing Address - Fax:406-586-2332
Practice Address - Street 1:2233 W KAGY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5938
Practice Address - Country:US
Practice Address - Phone:406-586-7873
Practice Address - Fax:406-586-2332
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT123829207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program