Healthcare Provider Details

I. General information

NPI: 1962019877
Provider Name (Legal Business Name): ASHLEY RENEE ELLENBERGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ASHLEY R CHLUPACEK

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 01/09/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ORANGEBURG AVE STE 330
MODESTO CA
95355-3396
US

IV. Provider business mailing address

W233N8317 SEVEN IRON CIR
SUSSEX WI
53089-1560
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-6000
  • Fax:
Mailing address:
  • Phone: 414-779-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222614-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: