Basic Information
| Provider Information | |||||||||
| NPI: | 1689921801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECKENRODE | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1681 E MIDDLETOWN RD | ||||||||
| Address2: | |||||||||
| City: | NORTH LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444529760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305195942 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1350 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444836608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308419011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 367500000X | RN333506 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 90633 | 01 | NBCRNA | OTHER | H142030 | 01 | OH | MEDICARE PTAN | OTHER | 0078506 | 05 | OH | MEDICAID | 12488375 | 01 | CAQH | OTHER |