Healthcare Provider Details

I. General information

NPI: 1720350416
Provider Name (Legal Business Name): ASHLEY NICOLE KLINE IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MCKINLEY STREET
OCEANSIDE CA
92057
US

IV. Provider business mailing address

191 MCKINLEY ST
OCEANSIDE CA
92057-4414
US

V. Phone/Fax

Practice location:
  • Phone: 240-997-4423
  • Fax:
Mailing address:
  • Phone: 240-997-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: