Provider Demographics
NPI:1568503597
Name:ELLINGSON, NANCY ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELLEN
Last Name:ELLINGSON
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 1:5344 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2567
Mailing Address - Country:US
Mailing Address - Phone:414-640-9820
Mailing Address - Fax:
Practice Address - Street 1:5344 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2567
Practice Address - Country:US
Practice Address - Phone:414-640-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38292100Medicaid