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NPI Code Detail

MEDICARE: RONEISHA ELLIS

MEDICARE: RONEISHA ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1063263135
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONEISHA ELLIS
Provider Business Mailing Address
First Line : 1111 W MOCKINGBIRD LN STE 480
Second Line :
City : DALLAS
State : TX
Zip : 75247-5062
Country : US
Telephone Number : 904-716-7988
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W MOCKINGBIRD LN STE 480
Second Line :
City : DALLAS
State : TX
Zip : 75247-5062
Country : US
Telephone Number : 904-716-7988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2024
Last Update Date : 03/28/2024

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Directions to “ RONEISHA ELLIS ” Practice Location

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