Provider Demographics
NPI:1659924520
Name:SERVATI, ASHLEY JANELLE (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANELLE
Last Name:SERVATI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 KAUKAALII ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-5209
Mailing Address - Country:US
Mailing Address - Phone:803-900-1758
Mailing Address - Fax:
Practice Address - Street 1:509 KAUKAALII ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-5209
Practice Address - Country:US
Practice Address - Phone:803-900-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse