Basic Information
Provider Information | |||||||||
NPI: | 1144749615 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEYER | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | MARITA-LYNN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOLDHEIDE | ||||||||
OtherFirstName: | ASHLEY | ||||||||
OtherMiddleName: | MARITA-LYNN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 200 SAINT CLAIR AVE | ||||||||
Address2: |   | ||||||||
City: | SAINT MARYS | ||||||||
State: | OH | ||||||||
PostalCode: | 458852400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193001129 | ||||||||
FaxNumber: | 4193949532 | ||||||||
Practice Location | |||||||||
Address1: | 1140 S KNOXVILLE AVE STE C | ||||||||
Address2: |   | ||||||||
City: | SAINT MARYS | ||||||||
State: | OH | ||||||||
PostalCode: | 458852609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193949595 | ||||||||
FaxNumber: | 4193949532 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/15/2017 | ||||||||
LastUpdateDate: | 04/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.021708 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 0105065 | 01 | OH | MEDICAID GROUP | OTHER | 0245411 | 05 | OH |   | MEDICAID | H548350 | 01 | OH | MEDICARE PTAN | OTHER | 9934723 | 01 | OH | MEDICARE GROUP PTAN | OTHER | 1184652539 | 01 | OH | GROUP NPI | OTHER | 34-1689161 | 01 | OH | GROUP TAX ID | OTHER |