Provider Demographics
NPI:1154956498
Name:FORTSCHNEIDER, ASHLEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:FORTSCHNEIDER
Suffix:
Gender:F
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 1:270 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRUSSELS
Mailing Address - State:IL
Mailing Address - Zip Code:62013-4468
Mailing Address - Country:US
Mailing Address - Phone:618-535-5467
Mailing Address - Fax:
Practice Address - Street 1:MERCY HOSPITAL ST. LOUIS
Practice Address - Street 2:615 S NEW BALLAS RD
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical