Provider Demographics
NPI:1720895063
Name:MCPHILLIPS, ASHLEY ALLISON (NURSE PRACTITONER)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ALLISON
Last Name:MCPHILLIPS
Suffix:
Gender:F
Credentials:NURSE PRACTITONER
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ALLISON
Other - Last Name:HEIDENREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 SHELBY ST STE 770-1356
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3268
Mailing Address - Country:US
Mailing Address - Phone:815-846-0871
Mailing Address - Fax:
Practice Address - Street 1:607 SHELBY ST STE 770-1356
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3268
Practice Address - Country:US
Practice Address - Phone:815-846-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily