Provider Demographics
NPI:1215485339
Name:MCDERMID, ASHLEY (CST)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCDERMID
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:3042 BRAMBLE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6901
Mailing Address - Country:US
Mailing Address - Phone:775-544-5533
Mailing Address - Fax:
Practice Address - Street 1:3042 BRAMBLE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6901
Practice Address - Country:US
Practice Address - Phone:760-731-0313
Practice Address - Fax:951-587-8277
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
166639OtherCST CERTIFICATE NUMBER