MEDICARE: MARCIA ELLIS 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	363L00000X	Nurse Practitioner	94617	CO

General Provider Information

NPI Number	:	1811026610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA ELLIS NP

Provider Business Mailing Address
First Line	:	17560 CHARTER PINES DR
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8478
Country	:	US
Telephone Number	:	719-481-9285
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 E WOODMEN RD STE 210
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3587
Country	:	US
Telephone Number	:	719-262-0852
Fax Number	:	719-262-0853

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/12/2015

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