Provider Demographics
NPI:1265309900
Name:ASHA BOURGEOIS, ASHA BOURGEOIS
Entity type:Individual
Prefix:
First Name:ASHA BOURGEOIS
Middle Name:
Last Name:ASHA BOURGEOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 N 62ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-1508
Mailing Address - Country:US
Mailing Address - Phone:414-719-1089
Mailing Address - Fax:414-719-1089
Practice Address - Street 1:6011 N 62ND ST APT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-1508
Practice Address - Country:US
Practice Address - Phone:414-719-1089
Practice Address - Fax:414-719-1089
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty