Healthcare Provider Details

I. General information

NPI: 1326683665
Provider Name (Legal Business Name): ELLEN MARIA FOLLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2950 STATE ROAD 67
LAKE GENEVA WI
53147-2655
US

IV. Provider business mailing address

29624 NETWORK PL
CHICAGO IL
60673-1296
US

V. Phone/Fax

Practice location:
  • Phone: 262-245-0535
  • Fax: 262-245-2248
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209020163
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: