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General NPI Number Information
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NPI Number | 1902040157
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Entity Type | Individual
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Provider Name | ROXANN T. ELLISON NE HIS #440 / BC-HIS
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 721 WEST 7TH STREET
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City | GRAND ISLAND
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State | NE
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Zip | 68801-4221
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Country | US
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Telephone | 308-382-9169
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Fax | 308-382-5088
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Provider Business Mailing Address
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Address Line | 721 WEST 7TH STREET
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City | GRAND ISLAND
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State | NE
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Zip | 68801-4221
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Country | US
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Telephone | 308-382-9169
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Fax | 308-382-5088
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | #440
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License Number State | NE
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