MEDICARE: MAUREEN E ASCIONE ACNP

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	363L00000X	Nurse Practitioner	4704244534	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1851637169	OTHER	MI	NPI

General Provider Information

NPI Number	:	1851637169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN E ASCIONE ACNP

Provider Business Mailing Address
First Line	:	1105 6TH ST.
Second Line	:	TRAVERSE OBSERVATION PHYSICIAN SERVICES
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-947-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	4624 N SPIDER LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8440
Country	:	US
Telephone Number	:	231-947-0673
Fax Number	:	801-740-2847

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

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	04/07/2015

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