Provider Demographics
NPI:1215433073
Name:DERJANI, ASHLEY (CNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DERJANI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:RAMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASHLEY SNOVER
Mailing Address - Street 1:1040 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily