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General NPI Number Information
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NPI Number | 1487229472
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Entity Type | Organization
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Legal Business Name | ELLEN VITAL SOLUTION LLC
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 9711 S MASON RD STE 125-650
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City | RICHMOND
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State | TX
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Zip | 77407-7167
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Country | US
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Telephone | 281-941-2887
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Fax | 281-816-1001
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Provider Business Mailing Address
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Address Line | 9711 S MASON RD STE 125-650
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City | RICHMOND
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State | TX
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Zip | 77407-7167
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Country | US
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Telephone | 281-941-2887
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Fax | 281-816-1001
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. EBERE OPARA
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Credential | NP-C
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Telephone | 346-313-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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