MEDICARE: TARAH 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
1	376K00000X	Nurse's Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0097664	OTHER	OH	WAVIER

General Provider Information

NPI Number	:	1871032599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARAH ELLIS

Provider Business Mailing Address
First Line	:	1348 PALMETTO AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-4240
Country	:	US
Telephone Number	:	419-283-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	1348 PALMETTO AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-4240
Country	:	US
Telephone Number	:	419-283-3387
Fax Number	:

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	04/02/2022

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Directions to “ TARAH ELLIS ” Practice Location

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