Healthcare Provider Details

I. General information

NPI: 1699294397
Provider Name (Legal Business Name): LINDA ELAINE ELLIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N BELTLINE DR
FLORENCE SC
29501-7402
US

IV. Provider business mailing address

221 N BELTLINE DR
FLORENCE SC
29501-7402
US

V. Phone/Fax

Practice location:
  • Phone: 843-758-6550
  • Fax: 843-664-8475
Mailing address:
  • Phone: 843-758-6550
  • Fax: 843-664-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61349-
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: