Provider Demographics
NPI:1679274906
Name:WARBURTON, ASHLEIGH DENISE
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DENISE
Last Name:WARBURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5074 W CHABLIS DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8562
Mailing Address - Country:US
Mailing Address - Phone:219-765-1060
Mailing Address - Fax:
Practice Address - Street 1:1101 E COOLSPRING AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6310
Practice Address - Country:US
Practice Address - Phone:219-874-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28216071A163WG0000X
IN71013842A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice