Basic Information
| Provider Information | |||||||||
| NPI: | 1518222553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEVENBERGEN | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E BOYD AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461402834 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 300 E BOYD AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461402834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174674500 | ||||||||
| FaxNumber: | 3174776321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 07/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 28170735A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.