Healthcare Provider Details

I. General information

NPI: 1740842475
Provider Name (Legal Business Name): ASHLEY C SIEMONH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 OLD WASHINGTON RD SUITE 302
WALDORF MD
20602
US

IV. Provider business mailing address

3500 OLD WASHINGTON RD SUITE 302
WALDORF MD
20602
US

V. Phone/Fax

Practice location:
  • Phone: 410-463-0174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR209519
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR209519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: