Provider Demographics
NPI:1700309234
Name:OLEK, ELLEN LOUISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LOUISE
Last Name:OLEK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:LOUISE
Other - Last Name:HEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2029
Mailing Address - Country:US
Mailing Address - Phone:630-217-8686
Mailing Address - Fax:
Practice Address - Street 1:130 2ND STREET
Practice Address - Street 2:THEDA CLARK MEDICAL PLAZA
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-831-5050
Practice Address - Fax:920-729-2104
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN270559363LF0000X
WI9062363LF0000X
IL209019307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209019307Medicaid
ILMO5237347OtherDEA