MEDICARE: ASHLEY J CARRANZA

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	363LF0000X	Family Nurse Practitioner	209029562	IL
2	363LF0000X	Family Nurse Practitioner	16344-33	WI

General Provider Information

NPI Number	:	1144074915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY J CARRANZA

Provider Business Mailing Address
First Line	:	6127 GREEN BAY RD STE 100
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2941
Country	:	US
Telephone Number	:	262-652-2887
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W KENSINGTON RD STE 3B
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1292
Country	:	US
Telephone Number	:	847-649-6288
Fax Number	:

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

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	06/25/2026

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Directions to “ ASHLEY J CARRANZA ” Practice Location

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