Individual
DR. MICHELE DEE ELLEFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APNP
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-4939
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8343
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
125406-030
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
3696-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528209574
—
WI
Enumeration date
03/19/2009
Last updated
10/20/2020
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