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General NPI Number Information
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NPI Number | 1588229256
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Entity Type | Individual
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Provider Name | ANGELA ELLIS
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Gender | Female
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 20333 W 151ST ST
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City | OLATHE
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State | KS
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Zip | 66061-5350
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Country | US
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Telephone | 913-791-4200
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Fax | 913-782-2381
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Provider Business Mailing Address
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Address Line | PO BOX 75443
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City | CHICAGO
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State | IL
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Zip | 60675-5443
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Country | US
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Telephone | 717-263-5562
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Fax | 717-263-1566
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 13-112223-062
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License Number State | KS
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