Provider Demographics
NPI:1841409265
Name:ASHLEY, JODY LEE (NP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LEE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15921 ANDRIE ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-3874
Mailing Address - Country:US
Mailing Address - Phone:763-441-2064
Mailing Address - Fax:
Practice Address - Street 1:15921 ANDRIE ST NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-3874
Practice Address - Country:US
Practice Address - Phone:763-441-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR069876-8363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care