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General NPI Number Information
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NPI Number | 1235174285
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Entity Type | Individual
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Provider Name | MARILYN E ELLIS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5000
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Fax | 228-523-4322
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Provider Business Mailing Address
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Address Line | 14256 CARRIAGE CIR
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City | GULFPORT
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State | MS
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Zip | 39503-5040
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Country | US
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Telephone | 228-832-1926
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Fax | 228-523-4322
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R566624
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN 028339 APO1951
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License Number State | LA
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