Provider Demographics
NPI:1538575048
Name:RADOCAY, ELLEN A (APNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:RADOCAY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:A
Other - Last Name:TORZEWSKI,BONZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:GREEN BAY
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:140B SCHOOL CREEK TRL
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-1095
Practice Address - Country:US
Practice Address - Phone:920-845-1370
Practice Address - Fax:920-845-1379
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174211-30163W00000X
WI5967-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
13673570OtherCAQH
F0814117OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
WIK400194136Medicare Oscar/Certification
WIK400168390Medicare Oscar/Certification