MEDICARE: ASHLEY MARIA DAUGHENBAUGH CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP007019B	PA

General Provider Information

NPI Number	:	1093714875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIA DAUGHENBAUGH CRNP

Provider Business Mailing Address
First Line	:	300 STATE ST
Second Line	:	SUITE 201
City	:	ERIE
State	:	PA
Zip	:	16507-1427
Country	:	US
Telephone Number	:	814-456-4241
Fax Number	:	814-453-3354

Provider Business Practice Location Address
First Line	:	300 STATE ST
Second Line	:	SUITE 201
City	:	ERIE
State	:	PA
Zip	:	16507-1427
Country	:	US
Telephone Number	:	814-456-4241
Fax Number	:	814-453-3354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/25/2013

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