Provider Demographics
NPI:1609908771
Name:ELEY, LUCINDA L (RN FNP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:L
Last Name:ELEY
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM, INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:1430 4TH STREET
Practice Address - Street 2:SCHOOL DISTRICT BELOIT WELLNESS CLINIC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-4442
Practice Address - Country:US
Practice Address - Phone:608-361-1950
Practice Address - Fax:608-365-1621
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2837-33363LF0000X
WI2837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36001500Medicaid
14766OtherDEAN HEALTH PLAN
WI039554176Medicare ID - Type Unspecified
WI36001500Medicaid