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General NPI Number Information
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NPI Number | 1164938544
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Entity Type | Individual
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Provider Name | SHANA B ELLIS CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 4083 CLOUD SPRINGS RD
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City | RINGGOLD
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State | GA
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Zip | 30736-8411
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Country | US
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Telephone | 706-820-6143
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Fax | 706-956-8171
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Provider Business Mailing Address
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Address Line | 5086 AL HIGHWAY 73
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City | BRYANT
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State | AL
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Zip | 35958-4316
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-145902
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License Number State | AL
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