Healthcare Provider Details

I. General information

NPI: 1336509652
Provider Name (Legal Business Name): ASHLEY GILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 E SUMNER ST
HARTFORD WI
53027-1608
US

IV. Provider business mailing address

722 EASTERN AVE
WEST BEND WI
53095-4116
US

V. Phone/Fax

Practice location:
  • Phone: 262-673-2300
  • Fax:
Mailing address:
  • Phone: 262-951-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6842-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: