Healthcare Provider Details

I. General information

NPI: 1700125663
Provider Name (Legal Business Name): MICHELLE LORRAINE ELLIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LORRAINE JOHNSON NP

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15501 E 13TH AVE
AURORA CO
80011-7203
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax: 303-343-1006
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-761-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0062218
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0990405
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: