Provider Demographics
NPI:1053807917
Name:LABANCA, ASHLEY BOURGOIS (PMHNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BOURGOIS
Last Name:LABANCA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BOURGOIS
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:712 N MANDAN ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3615
Mailing Address - Country:US
Mailing Address - Phone:701-527-5605
Mailing Address - Fax:
Practice Address - Street 1:712 N MANDAN ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3615
Practice Address - Country:US
Practice Address - Phone:888-454-3827
Practice Address - Fax:833-938-1401
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR37952363LP0808X
NYF404120363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health