Basic Information
| Provider Information | |||||||||
| NPI: | 1740935089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6209 SMOKY QUARTZ DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933135309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618081253 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 W COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613280245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 696393 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.