MEDICARE: MISS JESSICA LAUREN NASH ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1952431116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA LAUREN NASH ATC

Provider Business Mailing Address
First Line	:	9662 CANTERBURY RIDING
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-1401
Country	:	US
Telephone Number	:	703-655-2403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 MARLBORO PIKE
Second Line	:
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-3238
Country	:	US
Telephone Number	:	301-735-8401
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	05/22/2014

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