MEDICARE: MRS. LINDA ANN ELLIS R.N., M.N.

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN290452	CA

General Provider Information

NPI Number	:	1225052491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA ANN ELLIS R.N., M.N.

Provider Business Mailing Address
First Line	:	3440 VIKING DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2844
Country	:	US
Telephone Number	:	916-364-8395
Fax Number	:	916-364-5051

Provider Business Practice Location Address
First Line	:	3440 VIKING DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2844
Country	:	US
Telephone Number	:	916-364-8395
Fax Number	:	916-364-5051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/17/2010

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