Basic Information
| Provider Information | |||||||||
| NPI: | 1487140133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | JILL | ||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JANUSZEWSKI | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | JILL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 46247 365TH AVE | ||||||||
| Address2: | |||||||||
| City: | FRAZEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565448938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183711966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 415 JEFFERSON ST N | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564821264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313510 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 12729 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.