Healthcare Provider Details

I. General information

NPI: 1659195352
Provider Name (Legal Business Name): ASHLEY MICHELLE UTECH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MICHELLE ANDERSON

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 W WATERFORD LN
APPLETON WI
54913-8510
US

IV. Provider business mailing address

5337 W GRANDE MARKET DR
APPLETON WI
54913-8442
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-7445
  • Fax: 920-404-2351
Mailing address:
  • Phone: 920-731-7445
  • Fax: 920-404-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16145-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: