Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 16714 | OH |
NPI | 1003212382 |
---|---|
Provider Name | Ashley Degutis |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Marion, OH 43302-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122443 | (05) | OH |