Provider Demographics
NPI:1457744914
Name:ANDERSON, ASHLEY LAUREN (FNP)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:LAUREN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ADIRONDACK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-9334
Mailing Address - Country:US
Mailing Address - Phone:518-585-6708
Mailing Address - Fax:
Practice Address - Street 1:101 ADIRONDACK DR STE 2
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-9334
Practice Address - Country:US
Practice Address - Phone:518-585-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily