Basic Information
Provider Information
NPI: 1962924241
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIMPEL
FirstName: ASHLEY
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 HARVARD WAY
Address2:  
City: RENO
State: NV
PostalCode: 895022055
CountryCode: US
TelephoneNumber: 7759825262
FaxNumber: 7759825496
Practice Location
Address1: 10085 DOUBLE R BLVD STE 120
Address2:  
City: RENO
State: NV
PostalCode: 895214867
CountryCode: US
TelephoneNumber: 7759825000
FaxNumber: 7759823900
Other Information
ProviderEnumerationDate: 07/08/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN002645NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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