Provider Demographics
NPI:1841443678
Name:DURHAM, ASHLEE R (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:R
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2104
Mailing Address - Country:US
Mailing Address - Phone:724-226-8711
Mailing Address - Fax:724-226-0555
Practice Address - Street 1:1709 UNION AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2104
Practice Address - Country:US
Practice Address - Phone:724-226-8711
Practice Address - Fax:724-226-0555
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103206039Medicaid
PA103206039Medicaid