Healthcare Provider Details

I. General information

NPI: 1235522087
Provider Name (Legal Business Name): CHRISTIE ANN ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAPLE ST SUITE C233A
DANVERS MA
01923-4065
US

IV. Provider business mailing address

9 WOODLAND RD
WAKEFIELD MA
01880-3120
US

V. Phone/Fax

Practice location:
  • Phone: 978-304-8691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2289067
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: