MEDICARE: MS. ROSLYN ELLINGTON FNP

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	363L00000X	Nurse Practitioner	741757	TX

General Provider Information

NPI Number	:	1730365222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSLYN ELLINGTON FNP

Provider Business Mailing Address
First Line	:	9701 MEYER FOREST DR APT 13110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4325
Country	:	US
Telephone Number	:	318-773-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 MEYER FOREST DR APT 13110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4325
Country	:	US
Telephone Number	:	318-773-0227
Fax Number	:

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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