Provider Demographics
NPI:1164687984
Name:LAHA, ASHLEY KATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:KATHERINE
Last Name:LAHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:KATHERINE
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2880 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2880 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6456
Practice Address - Country:US
Practice Address - Phone:608-287-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2271023363A00000X
WI2271363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant