MEDICARE: MRS. ASHLEE ANNE PSENICKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		PA

General Provider Information

NPI Number	:	1700401817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEE ANNE PSENICKA

Provider Business Mailing Address
First Line	:	719 1/2 N FRANKLIN ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2124
Country	:	US
Telephone Number	:	717-984-0715
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 1/2 N FRANKLIN ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2124
Country	:	US
Telephone Number	:	717-984-0715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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