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NPI Code Detail

MEDICARE: MS. MARTHA A ELLIS PA-C

MEDICARE: MS. MARTHA A ELLIS PA-C
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
1363AM0700XMedical Physician Assistant2486AZ
2363A00000XPhysician AssistantPA10004629WA

General Provider Information

NPI Number : 1568483006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARTHA A ELLIS PA-C
Provider Business Mailing Address
First Line : PO BOX 88747
Second Line :
City : MILWAUKEE
State : WI
Zip : 53288-8747
Country : US
Telephone Number : 480-945-6777
Fax Number : 480-257-7310
Provider Business Practice Location Address
First Line : 4455 E CAMELBACK RD STE D155
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-2888
Country : US
Telephone Number : 480-626-2444
Fax Number : 888-473-4947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 01/10/2026

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