Healthcare Provider Details

I. General information

NPI: 1548310873
Provider Name (Legal Business Name): ELLAN L HOOD CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 BROADWAY SUITE 205
GARY IN
46409-1036
US

IV. Provider business mailing address

801 MACARTHUR BLVD SUITE 400A
MUNSTER IN
46321-2915
US

V. Phone/Fax

Practice location:
  • Phone: 219-887-4950
  • Fax: 219-887-4955
Mailing address:
  • Phone: 219-931-5227
  • Fax: 219-932-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number70000196A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: