Healthcare Provider Details

I. General information

NPI: 1184918914
Provider Name (Legal Business Name): MEGAN ASHLEY CIESLAK PA-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MEGAN ASHLEY RIVIERE

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

6134 S 20TH ST
MILWAUKEE WI
53221-5051
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7299
  • Fax:
Mailing address:
  • Phone: 414-429-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2760-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2760-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: