Provider Demographics
NPI:1235587890
Name:CHAZANOW, ASHLEY RANDLEMAN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RANDLEMAN
Last Name:CHAZANOW
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ROSE
Other - Last Name:RANDLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:101 HOLLY CREEK RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9509
Practice Address - Country:US
Practice Address - Phone:919-235-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020837363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235587890Medicaid