=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659337962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE M ASHLINE-SCHULTZ CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 WI DELLS PKWY S
-----------------------------------------------------
City | LAKE DELTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53940-0390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-254-5400
-----------------------------------------------------
Fax | 608-253-8585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 390
-----------------------------------------------------
City | LAKE DELTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53940-0390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-254-5400
-----------------------------------------------------
Fax | 608-253-8585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2455-033
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------