Individual
ASHLEY RENEE VANDERBOSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4455-23
WI
363AM0700X
Medical Physician Assistant
Primary
4455
WI
Other
Enumeration date
11/14/2018
Last updated
01/13/2021
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