Individual
MRS. LARISSA MAE ASHWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 N BRIDGE ST STE 1, CHIPPEWA FALLS, WI 54729-2483
(715) 226-0775
Mailing address
448 IRVINE ST, CHIPPEWA FALLS, WI 54729-3120
(715) 226-0777
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-2373409
—
WI
Enumeration date
08/24/2017
Last updated
08/24/2017
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