Healthcare Provider Details

I. General information

NPI: 1982613667
Provider Name (Legal Business Name): AMY J LASCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HEALTH SERVICES 333 EAST CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

UNIVERSITY HEALTH SERVICES 333 EAST CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-828-7603
  • Fax: 608-828-7644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2036
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: