Provider Demographics
NPI:1598272809
Name:WENDLANDT, ELLEN (LPN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WENDLANDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53006-0104
Mailing Address - Country:US
Mailing Address - Phone:920-970-6655
Mailing Address - Fax:
Practice Address - Street 1:557 DRURY PL
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4721
Practice Address - Country:US
Practice Address - Phone:920-979-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321214164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse