Basic Information
| Provider Information | |||||||||
| NPI: | 1306455514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 348 CLUBHOUSE DR | ||||||||
| Address2: | |||||||||
| City: | LUSBY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206573320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2409209393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14090 HG TRUEMAN RD STE 1300 | ||||||||
| Address2: | |||||||||
| City: | SOLOMONS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206883151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103942800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2020 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | R228318 | MD | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | R228318 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.