Healthcare Provider Details

I. General information

NPI: 1790604114
Provider Name (Legal Business Name): ASHLEY TUNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N 17TH ST
MILWAUKEE WI
53233-2104
US

IV. Provider business mailing address

1135 SALEM DR APT E
CHARLOTTE NC
28209-1463
US

V. Phone/Fax

Practice location:
  • Phone: 320-491-4282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: