Individual ProviderAshley LichtleNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140(260) 203-9600PECOS EnrollmentBased on the most recent information from CMS, provider Ashley Lichtle does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1750770830Provider TypeIndividualFull NameLichtle, AshleyCredentialNP-CGenderFemaleSole ProprietorNoEnumeration Date1/13/2015Last Updated4/26/2016Contact InformationPractice LocationPractice Address7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140Phone(260) 203-9600Fax(260) 203-9602Mailing LocationMailing AddressPO Box 11766, Fort Wayne, IN 46860-1766Phone(260) 203-9600Fax(260) 407-8006Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28191558AIndianaProvider IdentifiersIDDescriptionIssuerID201281000DescriptionMedicaidIssuerUnlistedIndiana