Basic Information
Provider Information | |||||||||
NPI: | 1659756765 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EWASKO | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CERTIIFIED REGISTERE | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEBER | ||||||||
OtherFirstName: | ASHLEY | ||||||||
OtherMiddleName: | E | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2 READS WAY | ||||||||
Address2: | SUITE #201 | ||||||||
City: | NEW CASTLE | ||||||||
State: | DE | ||||||||
PostalCode: | 197201630 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3027094709 | ||||||||
FaxNumber: | 3027094551 | ||||||||
Practice Location | |||||||||
Address1: | 4755 OGLETOWN STANTON RD | ||||||||
Address2: |   | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197180002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3027331000 | ||||||||
FaxNumber: | 3027332685 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/30/2015 | ||||||||
LastUpdateDate: | 01/04/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | L6-0A00733 | DE | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.