Healthcare Provider Details

I. General information

NPI: 1427696434
Provider Name (Legal Business Name): JAMIE MARIE ELLIS MSN, RN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE MARIE MCCANN

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NEW WAVERLY PL STE 305
CARY NC
27518-7404
US

IV. Provider business mailing address

600 NEW WAVERLY PL STE 305
CARY NC
27518-7404
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-7720
  • Fax:
Mailing address:
  • Phone: 919-954-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number292504
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5012811
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5012811
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: