Provider Demographics
NPI:1407029036
Name:EDDLEMAN, ELLEN LUCIEL (APNP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LUCIEL
Last Name:EDDLEMAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:LUCIEL
Other - Last Name:LOVELESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1613 CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7525
Mailing Address - Country:US
Mailing Address - Phone:920-451-6858
Mailing Address - Fax:
Practice Address - Street 1:1100 S 30TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5594
Practice Address - Country:US
Practice Address - Phone:920-684-1332
Practice Address - Fax:920-684-3651
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3162-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner