=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386907111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER C ASCHE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2012
-----------------------------------------------------
Last Update Date | 06/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49725 COUNTY 83
-----------------------------------------------------
City | STAPLES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56479-5280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-525-8344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2696 SOUTHSIDE DR SE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-760-2087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1737
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------