Provider Demographics
NPI:1487347159
Name:DRAKE, ASHLEY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 PINGREE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1726
Mailing Address - Country:US
Mailing Address - Phone:815-459-6655
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD STE 108
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1726
Practice Address - Country:US
Practice Address - Phone:815-459-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041467348163WM0705X
IL209027377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical