Healthcare Provider Details

I. General information

NPI: 1720527617
Provider Name (Legal Business Name): ELLEN OGDEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S STEMMONS FWY
LEWISVILLE TX
75067-4547
US

IV. Provider business mailing address

701 S STEMMONS FWY
LEWISVILLE TX
75067-4547
US

V. Phone/Fax

Practice location:
  • Phone: 972-316-6495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: