Provider Demographics
NPI:1770199051
Name:DESCORBETH, ASHLEY LUCKNISE (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LUCKNISE
Last Name:DESCORBETH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 ROBIN DR APT A
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5472
Mailing Address - Country:US
Mailing Address - Phone:847-296-2242
Mailing Address - Fax:
Practice Address - Street 1:8811 ROBIN DR APT A
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5472
Practice Address - Country:US
Practice Address - Phone:847-296-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily