Provider Demographics
NPI:1811352271
Name:SKARDA, ASHLEE ROSE
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:ROSE
Last Name:SKARDA
Suffix:
Gender:F
Credentials:
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 106
Mailing Address - Street 2:
Mailing Address - City:FRANCIS CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54214-0106
Mailing Address - Country:US
Mailing Address - Phone:920-323-9799
Mailing Address - Fax:
Practice Address - Street 1:9325 CTY RD K
Practice Address - Street 2:
Practice Address - City:FRANCIS CREEK
Practice Address - State:WI
Practice Address - Zip Code:54214-0106
Practice Address - Country:US
Practice Address - Phone:920-323-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program