Provider Demographics
NPI:1790288058
Name:ASHLEY, TAMRA J (CFNP IBCLC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:J
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:CFNP IBCLC
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4607 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9152
Mailing Address - Country:US
Mailing Address - Phone:989-640-0667
Mailing Address - Fax:
Practice Address - Street 1:401 W GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2819
Practice Address - Country:US
Practice Address - Phone:517-975-7300
Practice Address - Fax:517-975-7344
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704172273163WL0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant