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General NPI Number Information
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NPI Number | 1811052145
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Entity Type | Individual
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Provider Name | JOAN R ELLMORE CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 1301 SAM PERRY BLVD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8420
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Country | US
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Telephone | 540-741-3716
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Fax | 540-741-1096
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Provider Business Mailing Address
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Address Line | 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNI KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-6660
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Fax | 301-816-6308
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0001073375
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License Number State | VA
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