Healthcare Provider Details

I. General information

NPI: 1568070654
Provider Name (Legal Business Name): AMANDA D ELLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY ELLIS APRN

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER ST STE T100
ANCHORAGE AK
99508-4674
US

IV. Provider business mailing address

3841 PIPER ST STE T100
ANCHORAGE AK
99508-4674
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-3211
  • Fax:
Mailing address:
  • Phone: 907-550-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number158829
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number158829
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number158829
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: