Provider Demographics
NPI:1801187869
Name:ANDERSON, ASHLI LARAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ASHLI
Middle Name:LARAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 S. HIGLEY RD.
Mailing Address - Street 2:#114-132
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:480-276-0866
Mailing Address - Fax:480-993-3373
Practice Address - Street 1:3317 S. HIGLEY RD.
Practice Address - Street 2:#114-132
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-276-0866
Practice Address - Fax:480-993-3373
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046842164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse