Provider Demographics
NPI:1922207778
Name:CYR, ASHLEY A (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:CYR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3805B SPRING ST
Mailing Address - Street 2:SUITE 230 ATTN: HAZEL JOHNSON
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-687-4479
Mailing Address - Fax:262-687-5375
Practice Address - Street 1:3805B SPRING ST
Practice Address - Street 2:SUITE 230 ATTN: HAZEL JOHNSON
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1641
Practice Address - Country:US
Practice Address - Phone:262-687-4479
Practice Address - Fax:262-687-5375
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41945300Medicaid