Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | AP136660 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN152548 | GA |
NPI | 1356682215 |
---|---|
Provider Name | Ashley Danielle Deberry |
First Address | Gainesville, GA 30503-0658 |
Second Address | Gainesville, GA 30501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2013 |
Last Update Date | 27/07/2018 |