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General NPI Number Information
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NPI Number | 1720861438
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Entity Type | Individual
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Provider Name | ELLIS PRATHER NP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 2818 ASTORIA BLVD
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City | ASTORIA
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State | NY
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Zip | 11102-4751
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Country | US
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Telephone | 917-410-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 36 1ST AVE
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City | BOSTON
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State | MA
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Zip | 02129-4557
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Country | US
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Telephone | 413-687-5911
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 421714
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License Number State | NY
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