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General NPI Number Information
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NPI Number | 1023959814
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Entity Type | Individual
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Provider Name | MADISON JO ELLERBROCK
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Gender |
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 116 W FRONT ST STE A
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City | FINDLAY
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State | OH
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Zip | 45840-3478
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Country | US
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Telephone | 567-801-0792
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Fax |
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Provider Business Mailing Address
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Address Line | 9731 ROAD E
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City | LEIPSIC
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State | OH
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Zip | 45856-8910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OH
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