Provider Demographics
NPI:1851675979
Name:MICHELSEN, ASHLEY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:L
Last Name:MICHELSEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:550 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3186
Mailing Address - Country:US
Mailing Address - Phone:630-794-8671
Mailing Address - Fax:630-794-8662
Practice Address - Street 1:4700 GILBERT AVE
Practice Address - Street 2:SUITE 52
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1753
Practice Address - Country:US
Practice Address - Phone:708-387-1737
Practice Address - Fax:708-387-1739
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2015-03-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL700860033Medicare PIN