Healthcare Provider Details

I. General information

NPI: 1225035223
Provider Name (Legal Business Name): ANN WILSON ELLIS C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 PINE RD STE 220
CINCINNATI OH
45236-2191
US

IV. Provider business mailing address

8251 PINE RD STE 220
CINCINNATI OH
45236-2191
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-9191
  • Fax: 513-936-0222
Mailing address:
  • Phone: 513-936-9191
  • Fax: 513-936-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003153
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP-5172
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3153
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number05172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: