Provider Demographics
NPI:1225385487
Name:SKOSEY, ASHLEY BLAIR (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BLAIR
Last Name:SKOSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BLAIR
Other - Last Name:VAN LARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1185 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4887
Mailing Address - Country:US
Mailing Address - Phone:262-928-8476
Mailing Address - Fax:262-928-8444
Practice Address - Street 1:1185 CORPORATE CENTER DR
Practice Address - Street 2:SUITE #2
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4887
Practice Address - Country:US
Practice Address - Phone:262-928-8476
Practice Address - Fax:262-928-8444
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4919363L00000X
WI161460-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse