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General NPI Number Information
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NPI Number | 1972333847
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Entity Type | Individual
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Provider Name | ASHLEE MARY RUIZ-REYES
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Gender | Female
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 9555 76TH ST FL 2
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 262-577-8300
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Fax | 262-577-8414
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE STE 105
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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