Provider Demographics
NPI:1669717575
Name:BLACKWELL, ASHLY BROOK (RN)
Entity type:Individual
Prefix:
First Name:ASHLY
Middle Name:BROOK
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ASHLY
Other - Middle Name:BROOK
Other - Last Name:ZINKL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6411 N. ROBERT RD.
Mailing Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT #22/550
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-4042
Mailing Address - Fax:928-759-4030
Practice Address - Street 1:6411 N. ROBERT RD.
Practice Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT #22/550
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4042
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN172122163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool