Provider Demographics
NPI:1770982167
Name:DUBESHTER, ASHLEY Y (FNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:Y
Last Name:DUBESHTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:YAMAHATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL 3
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6133
Practice Address - Country:US
Practice Address - Phone:916-536-3540
Practice Address - Fax:916-536-2455
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003119363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03982469Medicaid
CAP01569012-EF10/12/15OtherRAILROAD MEDICARE-DV5277
NY03982469Medicaid
NYJ400171740/GRPBA0017Medicare PIN
NYJ400171734/GRP70008AMedicare PIN