1407029036 NPI number — MRS. ELLEN LUCIEL EDDLEMAN APNP

Table of content: MRS. ELLEN LUCIEL EDDLEMAN APNP (NPI 1407029036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407029036 NPI number — MRS. ELLEN LUCIEL EDDLEMAN APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDDLEMAN
Provider First Name:
ELLEN
Provider Middle Name:
LUCIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOVELESS
Provider Other First Name:
ELLEN
Provider Other Middle Name:
LUCIEL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407029036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 CARMEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEBOYGAN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53081-7525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-451-6858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 S 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-5594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-684-1332
Provider Business Practice Location Address Fax Number:
920-684-3651
Provider Enumeration Date:
04/03/2008

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: 363L00000X , with the licence number:  3162-033 , 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)





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