Basic Information
| Provider Information | |||||||||
| NPI: | 1730516832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIZZIMENTI | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STEPHENS | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 317 S. CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | QUARRYVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175661344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177867383 | ||||||||
| FaxNumber: | 7177868635 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 S. CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | QUARRYVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175661344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177867383 | ||||||||
| FaxNumber: | 7177868635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 01/28/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA056494 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.