Healthcare Provider Details

I. General information

NPI: 1669833422
Provider Name (Legal Business Name): ASHLEY MARKHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARIE TINCHER

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NITRO MARKET PL
CHARLESTON WV
25313-4401
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 304-769-0400
  • Fax: 304-769-0400
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1056
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: