Individual
RACHAEL MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
555 REDBIRD CIR, DE PERE, WI 54115-7977
(920) 338-6820
(920) 338-6829
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
62686-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2013
Last updated
10/11/2016
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