MEDICARE: ASHLEY DRISCOLL

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	247200000X	Other Technician		MI

General Provider Information

NPI Number	:	1962864686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DRISCOLL

Provider Business Mailing Address
First Line	:	4060 SPRINGER WAY
Second Line	:	APT 1622
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8329
Country	:	US
Telephone Number	:	269-420-6742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 SPRINGER WAY
Second Line	:	APT 1622
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8329
Country	:	US
Telephone Number	:	269-420-6742
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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Directions to “ ASHLEY DRISCOLL ” Practice Location

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