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NPI Code Detail

MEDICARE: MRS. LATOYA ELLIS

MEDICARE:  MRS. LATOYA  ELLIS
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
1363LF0000XFamily Nurse Practitioner4704233922MI
2363L00000XNurse Practitioner4704233922MI

General Provider Information

NPI Number : 1003465428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATOYA ELLIS
Provider Business Mailing Address
First Line : 1663 SAVANNAH CT
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-3681
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5452 FORT ST STE 200
Second Line :
City : TRENTON
State : MI
Zip : 48183-4638
Country : US
Telephone Number : 734-642-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2019
Last Update Date : 11/14/2022

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Directions to “ MRS. LATOYA ELLIS ” Practice Location

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