Provider Demographics
NPI:1487922381
Name:MERRILL, ASHLEY ROSE (LDM, CPM)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1394
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-1394
Mailing Address - Country:US
Mailing Address - Phone:971-322-7398
Mailing Address - Fax:
Practice Address - Street 1:235 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530
Practice Address - Country:US
Practice Address - Phone:971-322-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10152621176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife