Healthcare Provider Details

I. General information

NPI: 1174183271
Provider Name (Legal Business Name): VERA ELLIS-MULLER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERA ELLIS BS

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 N I 10 SERVICE RD W
METAIRIE LA
70006-6713
US

IV. Provider business mailing address

4201 N I 10 SERVICE RD W
METAIRIE LA
70006-6713
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2186
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: