Provider Demographics
NPI:1013787449
Name:MIERITZ, ASHTON (CRNA)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:MIERITZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:WI
Mailing Address - Zip Code:53582-9507
Mailing Address - Country:US
Mailing Address - Phone:608-341-9730
Mailing Address - Fax:
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID78392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered