Healthcare Provider Details

I. General information

NPI: 1093623811
Provider Name (Legal Business Name): RYAN ASHMORE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E GRAND AVE
ROTHSCHILD WI
54474-1024
US

IV. Provider business mailing address

1105 E GRAND AVE
ROTHSCHILD WI
54474-1024
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-2834
  • Fax:
Mailing address:
  • Phone: 715-842-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number252622-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: