Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 021002737 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | ME122828 | FL |
NPI | 1295046795 |
---|---|
Provider Name | Ashley E Manlove |
First Address | Urbana, IL 61801-2500 |
Second Address | Urbana, IL 61801-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 20/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003163495A | (05) | GA |
014932200 | (05) | FL |