Provider Demographics
NPI:1255658571
Name:CHRUSNIAK, HOLLIE ELLEN (RN, WCC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:ELLEN
Last Name:CHRUSNIAK
Suffix:
Gender:F
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 CALEB DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6669
Mailing Address - Country:US
Mailing Address - Phone:715-212-1595
Mailing Address - Fax:
Practice Address - Street 1:3105 CALEB DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-6669
Practice Address - Country:US
Practice Address - Phone:715-212-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159188-30163W00000X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health