Provider Demographics
NPI:1962864686
Name:DRISCOLL, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 SPRINGER WAY
Mailing Address - Street 2:APT 1622
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8329
Mailing Address - Country:US
Mailing Address - Phone:269-420-6742
Mailing Address - Fax:
Practice Address - Street 1:4060 SPRINGER WAY
Practice Address - Street 2:APT 1622
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8329
Practice Address - Country:US
Practice Address - Phone:269-420-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other