Healthcare Provider Details

I. General information

NPI: 1144422411
Provider Name (Legal Business Name): ELIZABETH LOUISE ELLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S MILLER AVE
LAFAYETTE CO
80026-1548
US

IV. Provider business mailing address

604 S MILLER AVE
LAFAYETTE CO
80026-1548
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-5381
  • Fax:
Mailing address:
  • Phone: 303-666-5381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number74135
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: