MEDICARE: MRS. ELLEN M ELINE CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R124819	MD
2	363LA2200X	Adult Health Nurse Practitioner	SP010305	PA

General Provider Information

NPI Number	:	1508868829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN M ELINE CRNP

Provider Business Mailing Address
First Line	:	155 STONEGATE DR
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2766
Country	:	US
Telephone Number	:	724-260-0129
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HALKET ST
Second Line	:	MAGEE WOMEN'S HOSPITAL, UPP - DEPARTMENT OF OB/GYN
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3108
Country	:	US
Telephone Number	:	412-641-5388
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/20/2010

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