MEDICARE: MRS. LANA ELLER NP

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	F07181356F	NC

General Provider Information

NPI Number	:	1497221097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANA ELLER NP

Provider Business Mailing Address
First Line	:	1640 ROYAL TROON CT
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-5519
Country	:	US
Telephone Number	:	864-320-1421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 ROYAL TROON CT
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-5519
Country	:	US
Telephone Number	:	864-320-1421
Fax Number	:

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

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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