MEDICARE: MRS. LINDA LOU ELLINGHUYSEN R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	88328-30	WI

General Provider Information

NPI Number	:	1902057615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA LOU ELLINGHUYSEN R.N.

Provider Business Mailing Address
First Line	:	1855 GARVIN HEIGHTS RD
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-5425
Country	:	US
Telephone Number	:	608-372-3971
Fax Number	:	608-372-1689

Provider Business Practice Location Address
First Line	:	1855 GARVIN HEIGHTS RD
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-5425
Country	:	US
Telephone Number	:	608-372-3971
Fax Number	:	608-372-1689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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