Healthcare Provider Details

I. General information

NPI: 1497659965
Provider Name (Legal Business Name): MRS. ASHLEY MAHLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 KAYLA LN
HANOVER MN
55341-4504
US

IV. Provider business mailing address

4934 101ST LN NE
CIRCLE PINES MN
55014-1504
US

V. Phone/Fax

Practice location:
  • Phone: 612-709-3681
  • Fax:
Mailing address:
  • Phone: 952-393-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2264349
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: