Healthcare Provider Details

I. General information

NPI: 1366083339
Provider Name (Legal Business Name): ASHLEY NICOLE PRICE PHDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6533 E JEFFERSON AVE APT LL6
DETROIT MI
48207-4340
US

IV. Provider business mailing address

6533 E JEFFERSON AVE APT LL6
DETROIT MI
48207-4340
US

V. Phone/Fax

Practice location:
  • Phone: 734-882-7931
  • Fax:
Mailing address:
  • Phone: 734-882-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: