Healthcare Provider Details

I. General information

NPI: 1336839596
Provider Name (Legal Business Name): ASHLEY SWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25320 75TH ST
SALEM WI
53168-9684
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-2336
  • Fax:
Mailing address:
  • Phone: 262-275-2101
  • Fax: 262-275-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number242029
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13922
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: