Provider Demographics
NPI:1174775506
Name:ASHMAN, ANGELA JEAN II
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:ASHMAN
Suffix:II
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 1:295 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-4401
Mailing Address - Country:US
Mailing Address - Phone:920-740-2191
Mailing Address - Fax:
Practice Address - Street 1:1981 GREENGROVE ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3921
Practice Address - Country:US
Practice Address - Phone:920-759-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162885-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35063700Medicaid