Provider Demographics
NPI:1841601515
Name:BOZEK, ASHLEY (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BOZEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-627-1102
Mailing Address - Fax:603-647-5524
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-627-1102
Practice Address - Fax:603-647-5524
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4982363A00000X
NH1228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15280Medicare UPIN