Provider Demographics
NPI:1700141884
Name:BENEDICT, ASHLEY RAE (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 KING JAMES PKWY
Mailing Address - Street 2:102
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 KING JAMES PKWY
Practice Address - Street 2:102
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3462
Practice Address - Country:US
Practice Address - Phone:440-471-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN368744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse