Provider Demographics
NPI:1871245423
Name:ROBELLARD, ASHLEY MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:ROBELLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 MARTY LEE LN
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-3837
Mailing Address - Country:US
Mailing Address - Phone:937-286-2171
Mailing Address - Fax:
Practice Address - Street 1:1130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2819
Practice Address - Country:US
Practice Address - Phone:937-208-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF01220930363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care