Provider Demographics
NPI:1790754950
Name:MCLEOD, ASHLEA J (PAC)
Entity Type:Individual
Prefix:
First Name:ASHLEA
Middle Name:J
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ASHELA
Other - Middle Name:J
Other - Last Name:SCHAUMBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1650 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6756
Practice Address - Country:US
Practice Address - Phone:507-529-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001256363A00000X
MN9627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA32833OtherWELLMARK
S98161Medicare UPIN
IAI19579Medicare PIN
MN970002373Medicare ID - Type Unspecified