Provider Demographics
NPI:1982096624
Name:DEFOURNOY, ASHLEY MARIE (FNP, RN)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE
Last Name:DEFOURNOY
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2053 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3245
Mailing Address - Country:US
Mailing Address - Phone:929-928-0099
Mailing Address - Fax:
Practice Address - Street 1:31 REDLEF ST
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4596
Practice Address - Country:US
Practice Address - Phone:516-521-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717208163W00000X
NY313453164W00000X
NY350350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse