Healthcare Provider Details

I. General information

NPI: 1942984489
Provider Name (Legal Business Name): ASHLI SRMEK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15954 RIVERS EDGE DR
HAYWARD WI
54843-7800
US

IV. Provider business mailing address

15735 W US HIGHWAY 63
HAYWARD WI
54843-6475
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-2541
  • Fax: 715-934-5090
Mailing address:
  • Phone: 715-934-0710
  • Fax: 715-598-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: