Provider Demographics
NPI:1043681570
Name:GYR, ASHLIE WILBON (FNP)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:WILBON
Last Name:GYR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:C
Other - Last Name:WILBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:80 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6980
Mailing Address - Country:US
Mailing Address - Phone:877-362-8362
Mailing Address - Fax:
Practice Address - Street 1:80 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6980
Practice Address - Country:US
Practice Address - Phone:877-362-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1030641363LF0000X
MDR176093363LF0000X
MI4704328104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily