Basic Information
| Provider Information | |||||||||
| NPI: | 1639432628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENCE | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 GRAMPIAN BLVD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177011900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703268723 | ||||||||
| FaxNumber: | 5703268922 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 HIGH STREET | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177013198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703212810 | ||||||||
| FaxNumber: | 5703212811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | OS017629 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.