MEDICARE: ASHLEY BANEY

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	374J00000X	Doula	45338800302201	IN

General Provider Information

NPI Number	:	1124364567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BANEY

Provider Business Mailing Address
First Line	:	2033 BAYER AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3414
Country	:	US
Telephone Number	:	616-821-8472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 BAYER AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3414
Country	:	US
Telephone Number	:	616-821-8472
Fax Number	:

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

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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Directions to “ ASHLEY BANEY ” Practice Location

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