Healthcare Provider Details

I. General information

NPI: 1649763129
Provider Name (Legal Business Name): BRYNN EMILY EHLERS JASCHEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRYNN EMILY EHLERS DO

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 LINEVILLE RD
GREEN BAY WI
54313-7152
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82083-21
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number195533
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: