Healthcare Provider Details

I. General information

NPI: 1699513945
Provider Name (Legal Business Name): ASHLEY LYNN REHBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CORPORATE DR
BEAVER DAM WI
53916-3116
US

IV. Provider business mailing address

130 CORPORATE DR
BEAVER DAM WI
53916-3116
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-3102
  • Fax: 920-855-8790
Mailing address:
  • Phone: 920-887-3102
  • Fax: 920-855-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15444
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: