Provider Demographics
NPI:1700090024
Name:DRAKE, ASHLEY LAUREL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREL
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N 96TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2497
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-934-0945
Practice Address - Street 1:909 N 96TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2497
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-934-0945
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5447390200000X
NE25720207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700090024Medicaid
NE10025555000Medicaid
NE10025555000Medicaid