Provider Demographics
NPI:1659337962
Name:ASHLINE-SCHULTZ, JACQUELINE M (CNM)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:ASHLINE-SCHULTZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:LAKE DELTON
Mailing Address - State:WI
Mailing Address - Zip Code:53940-0390
Mailing Address - Country:US
Mailing Address - Phone:608-254-5400
Mailing Address - Fax:608-253-8585
Practice Address - Street 1:530 WI DELLS PKWY S
Practice Address - Street 2:
Practice Address - City:LAKE DELTON
Practice Address - State:WI
Practice Address - Zip Code:53940-0390
Practice Address - Country:US
Practice Address - Phone:608-254-5400
Practice Address - Fax:608-253-8585
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2455-033363L00000X
WI367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60296OtherDEAN HEALTH INSURANCE
WI1044636OtherPHYSICIANS PLUS
WI41190500Medicaid
Q37026Medicare UPIN