Provider Demographics
NPI:1962019877
Name:ELLENBERGER, ASHLEY RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENEE
Last Name:ELLENBERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:CHLUPACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N62W23302 SILVER SPRING DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3889
Mailing Address - Country:US
Mailing Address - Phone:414-779-6757
Mailing Address - Fax:
Practice Address - Street 1:5380 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1366
Practice Address - Country:US
Practice Address - Phone:414-536-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI222614-30363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily