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Individual

MRS. ELLEN GRACE BARNSTABLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9695
(622) 249-5000
Mailing address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9695
(622) 249-5000

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
83862-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
11021938A
IN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100287398
WI
Enumeration date
03/25/2020
Last updated
11/06/2024
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