Provider Demographics
NPI:1912351610
Name:ANDERSEN, ASHLEY CAROL (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROL
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CAROL
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14001 RIDGEDALE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1747
Mailing Address - Country:US
Mailing Address - Phone:952-249-2000
Mailing Address - Fax:952-249-2099
Practice Address - Street 1:14001 RIDGEDALE DR STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1747
Practice Address - Country:US
Practice Address - Phone:952-249-2000
Practice Address - Fax:952-249-2099
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN67157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program