Healthcare Provider Details

I. General information

NPI: 1013854504
Provider Name (Legal Business Name): SANDRA LYNN ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST APT 2
CLARINDA IA
51632-1905
US

IV. Provider business mailing address

1000 E WASHINGTON ST APT 2
CLARINDA IA
51632-1905
US

V. Phone/Fax

Practice location:
  • Phone: 712-438-7651
  • Fax:
Mailing address:
  • Phone: 712-438-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: