Provider Demographics
NPI:1831939222
Name:DUNHAM, ASHLEY LEA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEA
Last Name:DUNHAM
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 1:802 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3044
Mailing Address - Country:US
Mailing Address - Phone:660-530-8414
Mailing Address - Fax:660-530-8421
Practice Address - Street 1:802 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3044
Practice Address - Country:US
Practice Address - Phone:660-530-8414
Practice Address - Fax:660-530-8421
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO051890310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility