MEDICARE: CAROL SUSANNAH ASHE ARNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	RN543538	CA

General Provider Information

NPI Number	:	1720082654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SUSANNAH ASHE ARNP

Provider Business Mailing Address
First Line	:	28464 OLD SPANISH TRL
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91390-5260
Country	:	US
Telephone Number	:	661-297-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 INDIAN HILLS RD
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1225
Country	:	US
Telephone Number	:	818-838-4500
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/27/2012

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