Provider Demographics
NPI:1356575807
Name:WILSON, ASHLEY REBECCA (ARNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E. INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207
Mailing Address - Country:US
Mailing Address - Phone:866-904-7721
Mailing Address - Fax:509-452-0362
Practice Address - Street 1:1525 SE KING DRIVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-248-3644
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60431795363LX0001X, 367A00000X
MARN2259457367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology