Provider Demographics
NPI:1225312747
Name:WIECZOREK, ELLEN ARLENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ARLENE
Last Name:WIECZOREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1540
Mailing Address - Country:US
Mailing Address - Phone:814-866-1380
Mailing Address - Fax:
Practice Address - Street 1:1158 W 30TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1540
Practice Address - Country:US
Practice Address - Phone:814-866-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN312638L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse