Provider Demographics
NPI:1003871831
Name:ASHEN, MARIE DOMINIQUE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DOMINIQUE
Last Name:ASHEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 FALLS RD
Mailing Address - Street 2:PAVILION 1 SUITE 360
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4515
Mailing Address - Country:US
Mailing Address - Phone:410-583-2740
Mailing Address - Fax:410-583-2741
Practice Address - Street 1:10755 FALLS RD
Practice Address - Street 2:PAVILION 1 SUITE 360
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:410-583-2740
Practice Address - Fax:410-583-2741
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD920700700Medicaid
MDKR34D133Medicare PIN
MD920700700Medicaid