Individual
JENELLE ELZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1615 MAPLE LN, ASHLAND, WI 54806-3610
(715) 685-5400
(715) 685-5102
Mailing address
1123 BEASER AVE, ASHLAND, WI 54806-2760
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
151450-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151450-30
LICENSE
WI
Enumeration date
06/02/2015
Last updated
06/02/2015
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