Provider Demographics
NPI:1710225727
Name:ROBILLARD, ASHLEY (LAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BERKSHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4438
Mailing Address - Country:US
Mailing Address - Phone:763-300-1399
Mailing Address - Fax:763-550-1500
Practice Address - Street 1:1000 BERKSHIRE LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4438
Practice Address - Country:US
Practice Address - Phone:763-300-1399
Practice Address - Fax:763-550-1500
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1595171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist