Provider Demographics
NPI:1376089433
Name:KULWICKI, ASHLEY LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LOUISE
Last Name:KULWICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LOUISE
Other - Last Name:WACHOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3290 N WELLNESS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7259
Practice Address - Country:US
Practice Address - Phone:616-685-7450
Practice Address - Fax:616-685-7455
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant