Provider Demographics
NPI:1528317690
Name:GUNDERSON, ASHLEY RENEE (PA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENEE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1276
Mailing Address - Country:US
Mailing Address - Phone:402-488-5600
Mailing Address - Fax:402-488-7649
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-488-5600
Practice Address - Fax:402-488-7649
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant