Individual
ERIN ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7152-033
WI
363LA2100X
Acute Care Nurse Practitioner
7152-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060908
—
WI
Enumeration date
08/03/2016
Last updated
02/22/2022
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