Healthcare Provider Details

I. General information

NPI: 1013198605
Provider Name (Legal Business Name): ELLEN CATHLEEN ALLISON RNCWHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N MACARTHUR BLVD STE 540
IRVING TX
75061-2256
US

IV. Provider business mailing address

2001 N MACARTHUR BLVD STE 540
IRVING TX
75061-2256
US

V. Phone/Fax

Practice location:
  • Phone: 972-253-5000
  • Fax: 972-253-1109
Mailing address:
  • Phone: 972-253-5000
  • Fax: 972-253-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number607332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: