MEDICARE: ASHLEIGH MAYENSCHEIN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	172230-030	WI

General Provider Information

NPI Number	:	1013289008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEIGH MAYENSCHEIN RN

Provider Business Mailing Address
First Line	:	1829 JEFFERSON DR
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-3247
Country	:	US
Telephone Number	:	920-495-1135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 JEFFERSON DR
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-3247
Country	:	US
Telephone Number	:	920-495-1135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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