Provider Demographics
NPI:1649593807
Name:ELLEN LISTING
Entity Type:Organization
Organization Name:ELLEN LISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-601-4055
Mailing Address - Street 1:14094 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BELOIT
Mailing Address - State:IL
Mailing Address - Zip Code:61080-2502
Mailing Address - Country:US
Mailing Address - Phone:815-601-4055
Mailing Address - Fax:
Practice Address - Street 1:14094 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BELOIT
Practice Address - State:IL
Practice Address - Zip Code:61080-2502
Practice Address - Country:US
Practice Address - Phone:815-601-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108005-030251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care