Provider Demographics
NPI:1356195648
Name:BIZZELL, ASHLEY (APNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BIZZELL
Suffix:
Gender:
Credentials:APNP, FNP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:RIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1297
Mailing Address - Country:US
Mailing Address - Phone:920-894-2636
Mailing Address - Fax:
Practice Address - Street 1:1001 SERVICE RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1297
Practice Address - Country:US
Practice Address - Phone:920-894-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14960363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100299618Medicaid