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NPI Code Detail

MEDICARE: ERICA ELLIS

MEDICARE: ERICA 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
1163W00000XRegistered NurseRN10031890MA

General Provider Information

NPI Number : 1710810874
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA ELLIS
Provider Business Mailing Address
First Line : 58 MAYFLOWER RD
Second Line :
City : HANSCOM AFB
State : MA
Zip : 01731-2682
Country : US
Telephone Number : 517-515-9111
Fax Number :
Provider Business Practice Location Address
First Line : 400 N INGALLS ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-2003
Country : US
Telephone Number : 734-763-5985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ ERICA ELLIS ” Practice Location

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