Provider Demographics
NPI:1689159493
Name:BELOUS, ASHLEY NICOLE (DNP, RN, AGACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BELOUS
Suffix:
Gender:F
Credentials:DNP, RN, AGACNP-BC
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, RN, AGACNP-BC
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1865
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care