Provider Demographics
NPI:1972018067
Name:CARDWELL, ASHLEY DIANE (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DIANE
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S GREENFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4012
Mailing Address - Country:US
Mailing Address - Phone:480-507-0700
Mailing Address - Fax:
Practice Address - Street 1:888 S GREENFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4012
Practice Address - Country:US
Practice Address - Phone:480-507-0700
Practice Address - Fax:480-507-7477
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972018067Medicaid