1295750479 NPI number — MRS. ELANA MARIE ROSE CONTORNO PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295750479 NPI number — MRS. ELANA MARIE ROSE CONTORNO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONTORNO
Provider First Name:
ELANA
Provider Middle Name:
MARIE ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295750479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36500 AURORA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53066-4899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-434-1000
Provider Business Mailing Address Fax Number:
262-434-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36500 AURORA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-434-1000
Provider Business Practice Location Address Fax Number:
262-434-5050
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1115 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)