Healthcare Provider Details

I. General information

NPI: 1508041005
Provider Name (Legal Business Name): MIRIAM C ELLENBURG-FERRO ACNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAM E ELLENBURG ACNP

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 08/12/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W FARIS RD STE 580
GREENVILLE SC
29605-4281
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7874
  • Fax: 864-455-8933
Mailing address:
  • Phone: 864-522-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberAPRN9345176
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24937
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: