Basic Information
Provider Information
NPI: 1003140427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRONGAARD
FirstName: ASHLEE
MiddleName: ELIZABETH
NamePrefix: MISS
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2879 E PRESIDIO RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857161539
CountryCode: US
TelephoneNumber: 5202511770
FaxNumber:  
Practice Location
Address1: 4280 N ORACLE RD STE 100
Address2:  
City: TUCSON
State: AZ
PostalCode: 857052101
CountryCode: US
TelephoneNumber: 1888381485
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/01/2009
LastUpdateDate: 03/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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