Provider Demographics
NPI:1992126171
Name:UNDERWOOD, ASHLEY (LPN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CHRISTINE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2360 WEYBURN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4066
Mailing Address - Country:US
Mailing Address - Phone:614-772-0057
Mailing Address - Fax:
Practice Address - Street 1:2360 WEYBURN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4066
Practice Address - Country:US
Practice Address - Phone:614-772-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133656164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse