Provider Demographics
NPI:1952964926
Name:DEGRAFFENREID, ASHLEY J (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:DEGRAFFENREID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21436 DWYER RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-4144
Mailing Address - Country:US
Mailing Address - Phone:660-723-4939
Mailing Address - Fax:
Practice Address - Street 1:17571 N DAM ACCESS RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-6396
Practice Address - Country:US
Practice Address - Phone:660-428-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002402164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse