MEDICARE: MS. SUNDIE WRIGHT ELLIS APRN, BC, FNP

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	363LP2300X	Primary Care Nurse Practitioner	667088	TX

General Provider Information

NPI Number	:	1245232297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUNDIE WRIGHT ELLIS APRN, BC, FNP

Provider Business Mailing Address
First Line	:	10717 LIPAN TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-6924
Country	:	US
Telephone Number	:	817-244-1592
Fax Number	:

Provider Business Practice Location Address
First Line	:	10717 LIPAN TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-6924
Country	:	US
Telephone Number	:	817-244-1592
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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