Healthcare Provider Details

I. General information

NPI: 1477950137
Provider Name (Legal Business Name): ASHLEY DIANA CHOUDOIR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY DIANA ORME-ROGERS

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-262-5420
  • Fax: 608-262-5624
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159402-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6293-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: