Individual
MR. KENNETH JAY ELLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6000
Mailing address
3841 E EDGERTON AVE, CUDAHY, WI 53110-1905
(414) 405-1971
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
184751-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184751-30
WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
Enumeration date
05/11/2017
Last updated
05/11/2017
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