Healthcare Provider Details

I. General information

NPI: 1437605219
Provider Name (Legal Business Name): STEVEN ELLISON NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 S FOOTHILLS BLVD STE 1
YUMA AZ
85367-5895
US

IV. Provider business mailing address

11814 S FOOTHILLS BLVD STE 1
YUMA AZ
85367-5895
US

V. Phone/Fax

Practice location:
  • Phone: 928-248-4734
  • Fax:
Mailing address:
  • Phone: 928-248-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP10006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: