Provider Demographics
NPI:1710458039
Name:SMITH, ASHLEY MARIE-NICHOLE (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE-NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CULVER BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7765
Mailing Address - Country:US
Mailing Address - Phone:661-547-3737
Mailing Address - Fax:
Practice Address - Street 1:412 CULVER BLVD APT 8
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7765
Practice Address - Country:US
Practice Address - Phone:661-547-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-15
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95181147163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice