Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 01086479A | IN |
NPI | 1285167825 |
---|---|
Provider Name | Ashley Berish |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46805-4764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 09/09/2021 |