Basic Information
| Provider Information | |||||||||
| NPI: | 1366171878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NETTLES | ||||||||
| FirstName: | ASHLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 753 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441463867 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11900 FAIRHILL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441201062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169838030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2022 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN.436690 | OH | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.