Healthcare Provider Details

I. General information

NPI: 1902933997
Provider Name (Legal Business Name): NORMA M ELLIS RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST MMC SCHOOL HEALTH
BRONX NY
10467-2401
US

IV. Provider business mailing address

121 AUGUSTINE RD
WHITE PLAINS NY
10603-2039
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4060
  • Fax:
Mailing address:
  • Phone: 718-933-2400
  • Fax: 718-367-8168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF330323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: