Provider Demographics
NPI:1063959021
Name:LINDGREN, ELLEN MARY (RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 MAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2826
Mailing Address - Country:US
Mailing Address - Phone:608-217-5938
Mailing Address - Fax:
Practice Address - Street 1:6621 MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2826
Practice Address - Country:US
Practice Address - Phone:608-217-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67685-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse