Basic Information
| Provider Information | |||||||||
| NPI: | 1902408685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEAD | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18599 LAKE SHORE BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441191074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1638360672 | ||||||||
| FaxNumber: | 2163835309 | ||||||||
| Practice Location | |||||||||
| Address1: | 18599 LAKE SHORE BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441191074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163835303 | ||||||||
| FaxNumber: | 2163835309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2020 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.006655RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.