Provider Demographics
NPI:1174902696
Name:MARMON, ASHLEY (FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MARMON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W JEFFERSON ST
Mailing Address - Street 2:APT 26 E
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1378
Mailing Address - Country:US
Mailing Address - Phone:309-265-5345
Mailing Address - Fax:
Practice Address - Street 1:12528 SR 78
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-6866
Practice Address - Country:US
Practice Address - Phone:309-543-4253
Practice Address - Fax:309-543-1060
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily