MEDICARE: MRS. ANGELA ELLARD APRN-BC

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	251J00000X	Nursing Care Agency	RN.396624	OH
2	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.021512	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.021512	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558993378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA ELLARD APRN-BC

Provider Business Mailing Address
First Line	:	3406 ERIE AVE STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1741
Country	:	US
Telephone Number	:	513-255-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 ERIE AVE STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1741
Country	:	US
Telephone Number	:	513-255-5555
Fax Number	:

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	03/14/2025

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