Provider Demographics
NPI:1447342910
Name:ASHLINE, JEFFREY L (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:ASHLINE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 WESTMARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2271
Mailing Address - Country:US
Mailing Address - Phone:563-582-6202
Mailing Address - Fax:563-582-5909
Practice Address - Street 1:4005 WESTMARK DR STE 200
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2271
Practice Address - Country:US
Practice Address - Phone:563-582-6202
Practice Address - Fax:563-582-5909
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS24628Medicare UPIN