Provider Demographics
NPI:1932345436
Name:CONNER, ASHLEY DARLENE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DARLENE
Last Name:CONNER
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 1:321 W SAXON ST
Mailing Address - Street 2:
Mailing Address - City:IVANHOE
Mailing Address - State:MN
Mailing Address - Zip Code:56142-9555
Mailing Address - Country:US
Mailing Address - Phone:507-694-1123
Mailing Address - Fax:
Practice Address - Street 1:321 W SAXON ST
Practice Address - Street 2:
Practice Address - City:IVANHOE
Practice Address - State:MN
Practice Address - Zip Code:56142-9555
Practice Address - Country:US
Practice Address - Phone:507-694-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1052289-1-WS385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care