MEDICARE: ASHLEY DRAIN

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	164W00000X	Licensed Practical Nurse	PN308879	PA

General Provider Information

NPI Number	:	1942083522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DRAIN

Provider Business Mailing Address
First Line	:	4036 DAYTON RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-5119
Country	:	US
Telephone Number	:	267-307-4866
Fax Number	:

Provider Business Practice Location Address
First Line	:	4036 DAYTON RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-5119
Country	:	US
Telephone Number	:	267-307-4866
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	09/15/2023

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Directions to “ ASHLEY DRAIN ” Practice Location

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