Provider Demographics
NPI:1750662185
Name:WILLS, ASHLEY RACHELLE
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RACHELLE
Last Name:WILLS
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 1:8832 STATE ROUTE 185
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45308-9788
Mailing Address - Country:US
Mailing Address - Phone:937-418-2792
Mailing Address - Fax:
Practice Address - Street 1:8832 STATE ROUTE 185
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:OH
Practice Address - Zip Code:45308-9788
Practice Address - Country:US
Practice Address - Phone:937-418-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.146997-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse