Provider Demographics
NPI:1578375747
Name:METTENBRINK, ELLEN L
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:METTENBRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SURFSIDE CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-2305
Mailing Address - Country:US
Mailing Address - Phone:402-304-5263
Mailing Address - Fax:
Practice Address - Street 1:1235 SURFSIDE CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-2305
Practice Address - Country:US
Practice Address - Phone:402-304-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care