Provider Demographics
NPI:1235501941
Name:ELSEN, GEORGIANNE IV (RN)
Entity Type:Individual
Prefix:
First Name:GEORGIANNE
Middle Name:
Last Name:ELSEN
Suffix:IV
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:GEORGIANNE
Other - Middle Name:
Other - Last Name:ELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1203 COUNTY ROAD AA
Mailing Address - Street 2:
Mailing Address - City:NEKOOSA
Mailing Address - State:WI
Mailing Address - Zip Code:54457-9720
Mailing Address - Country:US
Mailing Address - Phone:715-886-5037
Mailing Address - Fax:
Practice Address - Street 1:1203 COUNTY ROAD AA
Practice Address - Street 2:
Practice Address - City:NEKOOSA
Practice Address - State:WI
Practice Address - Zip Code:54457-9720
Practice Address - Country:US
Practice Address - Phone:715-886-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI193058-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse