Healthcare Provider Details

I. General information

NPI: 1326346826
Provider Name (Legal Business Name): ELLEN M HAMBEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915-1396
US

IV. Provider business mailing address

W2447 WESTERN DR
FREEDOM WI
54913-6949
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2611
  • Fax:
Mailing address:
  • Phone: 507-272-0864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 146035-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: