Provider Demographics
NPI:1174018584
Name:MCGUIRE, ASHLEY A (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12203 CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3388
Mailing Address - Country:US
Mailing Address - Phone:262-387-8200
Mailing Address - Fax:262-387-8239
Practice Address - Street 1:12203 CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-387-8200
Practice Address - Fax:262-387-8239
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8478-033363L00000X
WI8478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100079172Medicaid