Provider Demographics
NPI:1730359910
Name:BRICKNER, ASHLEY ROSE
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ROSE
Last Name:BRICKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 KILBURY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4533
Mailing Address - Country:US
Mailing Address - Phone:740-387-7466
Mailing Address - Fax:
Practice Address - Street 1:516 KILBURY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4533
Practice Address - Country:US
Practice Address - Phone:740-387-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH102194252799Medicaid