MEDICARE: DANIELLE 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
1	164W00000X	Licensed Practical Nurse	160671	OH
2	163W00000X	Registered Nurse	520289	OH

General Provider Information

NPI Number	:	1508229923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ELLIS

Provider Business Mailing Address
First Line	:	5448 GLENRIDGE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1608
Country	:	US
Telephone Number	:	419-705-6436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5448 GLENRIDGE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1608
Country	:	US
Telephone Number	:	419-705-6436
Fax Number	:

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

Provider Enumeration Date	:	04/02/2016
Last Update Date	:	03/22/2024

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Directions to “ DANIELLE ELLIS ” Practice Location

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