Healthcare Provider Details

I. General information

NPI: 1558952689
Provider Name (Legal Business Name): ASHLEY VALLE LUCAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 25TH ST
BALTIMORE MD
21218-5003
US

IV. Provider business mailing address

375 CHISELED STONE RD
SYKESVILLE MD
21784-8656
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1717
  • Fax:
Mailing address:
  • Phone: 443-865-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191410
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR191410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: