Healthcare Provider Details

I. General information

NPI: 1932895018
Provider Name (Legal Business Name): BRITTANI ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8985 S DURANGO DR UNIT 1175
LAS VEGAS NV
89113-6128
US

IV. Provider business mailing address

8985 S DURANGO DR UNIT 1175
LAS VEGAS NV
89113-6128
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax:
Mailing address:
  • Phone: 323-203-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number22778383
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: