MEDICARE: AMY MICHELE ELLISON CNP

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	363L00000X	Nurse Practitioner	71006091A	IN
2	363LF0000X	Family Nurse Practitioner	1176681	TX
3	363LF0000X	Family Nurse Practitioner	209012868	IL
4	363LF0000X	Family Nurse Practitioner	231018	AR
5	363L00000X	Nurse Practitioner	SP032117	PA
6	363L00000X	Nurse Practitioner	209012868	IL
7	363LF0000X	Family Nurse Practitioner	5021341	NC
8	363L00000X	Nurse Practitioner	0037682	OH
9	363LF0000X	Family Nurse Practitioner	38142	TN
10	363LF0000X	Family Nurse Practitioner	71006091A	IN
11	363LF0000X	Family Nurse Practitioner	2025003230	MO
12	363LF0000X	Family Nurse Practitioner	APRN-4938	HI
13	363L00000X	Nurse Practitioner	315543	AZ
14	363LF0000X	Family Nurse Practitioner	907204	MS
15	363LF0000X	Family Nurse Practitioner	11035916	FL

General Provider Information

NPI Number	:	1457731127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELE ELLISON CNP

Provider Business Mailing Address
First Line	:	700 E OGDEN AVE STE 202
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1296
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE STE 202
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1296
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	10/22/2025

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