Provider Demographics
NPI:1366293250
Name:HARRIS, ASHTON (APRN, CNP)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 415
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3133
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-694-4102
Practice Address - Street 1:676 N SAINT CLAIR ST STE 415
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3133
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-694-4102
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041534445163W00000X
IL209.029657363LF0000X
IL209029657363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily