Provider Demographics
NPI:1871969501
Name:ASHLEY, JOHANNA (CRNA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:PERALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0757
Mailing Address - Country:US
Mailing Address - Phone:256-764-9697
Mailing Address - Fax:
Practice Address - Street 1:1122 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3361
Practice Address - Country:US
Practice Address - Phone:256-560-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-154311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered