Provider Demographics
NPI:1194503938
Name:DEJARNETTE, ASHLEY MARIE I
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:MARIE
Last Name:DEJARNETTE
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:DEJARNETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6291 VINCENT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8258
Mailing Address - Country:US
Mailing Address - Phone:614-678-2120
Mailing Address - Fax:
Practice Address - Street 1:6291 VINCENT GEORGE DR # A
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8258
Practice Address - Country:US
Practice Address - Phone:614-678-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTY698917374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty