MEDICARE: MRS. LOIS ELLEN AHALT CRNP

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	163WX0106X	Occupational Health Registered Nurse	R070660	MD

General Provider Information

NPI Number	:	1841339629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS ELLEN AHALT CRNP

Provider Business Mailing Address
First Line	:	2406 HUNTERS CHASE CT
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-2616
Country	:	US
Telephone Number	:	301-514-5735
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 RESEARCH PLAZA
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-9210
Country	:	US
Telephone Number	:	301-619-5540
Fax Number	:	301-619-5591

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	10/23/2018

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