Provider Demographics
NPI:1376979013
Name:CALLAWAY, ASHLEY E (PA)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:E
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:MISZKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:
Practice Address - Street 1:555 QUALITY CT
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180-9006
Practice Address - Country:US
Practice Address - Phone:920-532-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3222-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114744OtherNATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
WIK400104379Medicare Oscar/Certification
WIK400269760Medicare Oscar/Certification