Individual
NATALIE J ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9694
(262) 843-4422
Mailing address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9694
(262) 843-4422
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2048
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41954600
—
WI
Enumeration date
05/08/2007
Last updated
12/03/2021
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