MEDICARE: ASHLEY NICOLE LANE

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	106S00000X	Behavior Technician		MD

General Provider Information

NPI Number	:	1194372813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE LANE

Provider Business Mailing Address
First Line	:	9909 BLUNDON DR APT 303
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5219
Country	:	US
Telephone Number	:	443-359-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	9909 BLUNDON DR APT 303
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5219
Country	:	US
Telephone Number	:	443-359-1771
Fax Number	:

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

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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Directions to “ ASHLEY NICOLE LANE ” Practice Location

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