MEDICARE: MRS. ERIN RAY ANN ELLIS RN, MS, FNP-BC

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	363LF0000X	Family Nurse Practitioner	APN 196	NV

General Provider Information

NPI Number	:	1548221583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN RAY ANN ELLIS RN, MS, FNP-BC

Provider Business Mailing Address
First Line	:	1916 SUMMER POINT ST UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-2645
Country	:	US
Telephone Number	:	702-806-1997
Fax Number	:

Provider Business Practice Location Address
First Line	:	7040 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8607
Country	:	US
Telephone Number	:	702-792-6700
Fax Number	:	401-652-9787

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/02/2016

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