Provider Demographics
NPI:1689975922
Name:ASHWELL, JONIKA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JONIKA
Middle Name:MARIE
Last Name:ASHWELL
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 1:1420 SAPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8076
Mailing Address - Country:US
Mailing Address - Phone:678-216-7286
Mailing Address - Fax:
Practice Address - Street 1:348 WARNER AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1463
Practice Address - Country:US
Practice Address - Phone:315-428-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse