Provider Demographics
NPI:1134791049
Name:HEARLD, ASHLEY LYNN
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:HEARLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52251 CAMPFIRE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8971
Mailing Address - Country:US
Mailing Address - Phone:269-689-9415
Mailing Address - Fax:
Practice Address - Street 1:52565 IN 933
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637
Practice Address - Country:US
Practice Address - Phone:574-247-7044
Practice Address - Fax:574-703-3270
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28222806A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse