Individual
MRS. SUSAN CORENE ELLIOTT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4350 MARINERS CIR, OCONOMOWOC, WI 53066-4565
(262) 567-7735
Mailing address
4350 MARINERS CIR, OCONOMOWOC, WI 53066-4565
(262) 567-7735
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
22726-031
WI
Other
Enumeration date
04/11/2006
Last updated
07/08/2007
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