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General NPI Number Information
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NPI Number | 1548595713
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Entity Type | Individual
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Provider Name | ELLEN MCCORMICK AGNP-BC, MS, RD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 900 23RD ST NW
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City | WASHINGTON
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State | DC
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Zip | 20037-2342
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Country | US
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Telephone | 202-715-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 250 WEST 100 STREET APT 719
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City | NEW YORK
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State | NY
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Zip | 10025
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX2995
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 661054-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN1034391
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 306800
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License Number State | NY
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