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General NPI Number Information
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NPI Number | 1184387946
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Entity Type | Individual
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Provider Name | LISA ELLINGSEN PMHNP-BC, MSN
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 367 PINE ST
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City | SPRINGFIELD
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State | MA
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Zip | 01105-1930
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Country | US
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Telephone | 413-737-1426
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Fax |
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Provider Business Mailing Address
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Address Line | 59 LAUREL PARK
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City | NORTHAMPTON
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State | MA
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Zip | 01060-1196
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Country | US
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Telephone | 413-231-2878
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2302944
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License Number State | MA
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