Provider Demographics
NPI:1457911497
Name:CHARZUK, ASHLEY (CPSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CHARZUK
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 LOS ARBOLES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1943
Mailing Address - Country:US
Mailing Address - Phone:505-800-7092
Mailing Address - Fax:505-888-2851
Practice Address - Street 1:3301 LOS ARBOLES AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1943
Practice Address - Country:US
Practice Address - Phone:505-800-7092
Practice Address - Fax:505-888-2851
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM848175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist