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General NPI Number Information
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NPI Number | 1124186069
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Entity Type | Individual
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Provider Name | CHRISTINE A ELLINGSWORTH L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 81 CHURCH STREET
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City | ALEXANDRIA
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State | NY
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Zip | 13607
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Country | US
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Telephone | 315-482-9719
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Fax |
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Provider Business Mailing Address
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Address Line | 219 SAINT MARY ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2136
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Country | US
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Telephone | 315-785-9148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 134871-1
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License Number State | NY
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