Provider Demographics
NPI:1831764794
Name:DETTRA, ASHLEY RINALDI (MSN, RN, CCRN, NP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RINALDI
Last Name:DETTRA
Suffix:
Gender:F
Credentials:MSN, RN, CCRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RIVERFRONT BLVD APT 1102
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1166
Mailing Address - Country:US
Mailing Address - Phone:201-675-6046
Mailing Address - Fax:
Practice Address - Street 1:43 YAWPO AVE STE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2717
Practice Address - Country:US
Practice Address - Phone:201-337-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01153600363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology