Basic Information
Provider Information
NPI: 1568808400
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERROLD
FirstName: ASHLEY
MiddleName: B
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 754 FAIRWAY DR
Address2:  
City: BOULDER CITY
State: NV
PostalCode: 890053429
CountryCode: US
TelephoneNumber: 7023383404
FaxNumber:  
Practice Location
Address1: 930 N 4TH ST
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891011001
CountryCode: US
TelephoneNumber: 7023834044
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/20/2013
LastUpdateDate: 05/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN71981NVY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home