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Ellen June Radeker

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

225 Baldwin Ave, Charlotte, NC 28204-3109

PECOS Enrollment

This provider is enrolled in PECOS as ELLEN RADEKER.

Based on the most recent information from CMS, provider Ellen June Radeker is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:59 PM.

Profile Details

Provider ID
1558133355
Provider Type
Individual
Full Name
Radeker, Ellen June
Credential
FNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
10/25/2023
Last Updated
8/4/2025

Contact Information

Practice Location

225 Baldwin Ave, Charlotte, NC 28204-3109

(704) 376-1605

(704) 335-8448

Mailing Location

225 Baldwin Ave, Charlotte, NC 28204-3109

(704) 376-1605

(704) 335-8448

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5020439 North Carolina
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 11029037 Florida

Ellen June Radeker

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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