Individual
KELLY A ISHERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2350 N LAKE DR, SUITE 206, MILWAUKEE, WI 53211-4528
(414) 298-7280
(414) 298-7281
Mailing address
2350 N LAKE DR, SUITE 206, MILWAUKEE, WI 53211-4528
(414) 298-7280
(414) 298-7281
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1675-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42866700
NETWORK HEALTH - T19
WI
01
—
42866700
MANAGED HEALTH SERVICES
—
05
—
42866700
—
WI
Enumeration date
09/02/2006
Last updated
11/24/2010
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