Provider Demographics
NPI:1295296697
Name:DIFREDERICO, ASHLYN CLAY (NP)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:CLAY
Last Name:DIFREDERICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST STE 6252
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-6730
Mailing Address - Fax:770-420-3422
Practice Address - Street 1:30 E APPLE ST STE 6252
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-6730
Practice Address - Fax:770-420-3422
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN267756363LF0000X
OHAPRN.CNP.0036367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.534014OtherRN LICENSURE
GARN267756OtherRN LICENSE