Provider Demographics
NPI:1194599977
Name:GUERCIO, ASHLEY (CPM, LM)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GUERCIO
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5415
Mailing Address - Country:US
Mailing Address - Phone:801-372-9266
Mailing Address - Fax:
Practice Address - Street 1:98 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5415
Practice Address - Country:US
Practice Address - Phone:801-372-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-153176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife