Provider Demographics
NPI:1912450750
Name:DUNLAP, ASHLEY (BS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 KENOWA AVE SW
Mailing Address - Street 2:APT. 8
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9413
Mailing Address - Country:US
Mailing Address - Phone:248-763-4439
Mailing Address - Fax:
Practice Address - Street 1:6267 KENOWA AVE SW
Practice Address - Street 2:APT. 8
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-9413
Practice Address - Country:US
Practice Address - Phone:248-763-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID541072261032247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other