Provider Demographics
NPI:1780460915
Name:BROTHERTON, ASHLEY JOANNE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JOANNE
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2250
Mailing Address - Country:US
Mailing Address - Phone:585-297-5398
Mailing Address - Fax:
Practice Address - Street 1:94 OLEAN ST STE 210
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2531
Practice Address - Country:US
Practice Address - Phone:716-652-0237
Practice Address - Fax:716-652-0983
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF35271301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily