Provider Demographics
NPI:1609320878
Name:ELLINGSON, LEANN
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:
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 326
Mailing Address - Street 2:
Mailing Address - City:BIRCHWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54817-0326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W 725 CTH D
Practice Address - Street 2:
Practice Address - City:BIRCHWOOD
Practice Address - State:WI
Practice Address - Zip Code:54817
Practice Address - Country:US
Practice Address - Phone:763-607-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI188030-30163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control