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General NPI Number Information
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NPI Number | 1801527288
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Entity Type | Individual
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Provider Name | COURTNEY ELLIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 8064 MARKET ST
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City | WILMINGTON
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State | NC
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Zip | 28411-0013
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Country | US
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Telephone | 910-796-7767
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Fax | 910-686-7159
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Provider Business Mailing Address
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Address Line | 1202 MEDICAL CENTER DR
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City | WILMINGTON
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State | NC
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Zip | 28401-7307
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Country | US
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Telephone | 910-341-1540
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Fax | 910-431-4048
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 9117081
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License Number State | FL
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