Provider Demographics
NPI:1376858654
Name:ELLERBROEK, ALENA DAVIDA (MSN,FNP)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:DAVIDA
Last Name:ELLERBROEK
Suffix:
Gender:F
Credentials:MSN,FNP
Other - Prefix:
Other - First Name:ALENA
Other - Middle Name:DAVIDA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2400
Mailing Address - Country:US
Mailing Address - Phone:319-234-6000
Mailing Address - Fax:319-234-6001
Practice Address - Street 1:3741 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5215
Practice Address - Country:US
Practice Address - Phone:319-234-6000
Practice Address - Fax:319-234-6001
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA123879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily