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NPI Code Detail

MEDICARE: KELLY ELLIS NURSE PRACTITIONER

MEDICARE: KELLY ELLIS NURSE PRACTITIONER
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
1363LW0102XWomen's Health Nurse Practitioner4704295494NSA200E5MI

General Provider Information

NPI Number : 1821615279
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ELLIS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1000 HOUGHTON AVE
Second Line :
City : SAGINAW
State : MI
Zip : 48602-5303
Country : US
Telephone Number : 989-746-7500
Fax Number :
Provider Business Practice Location Address
First Line : 1000 HOUGHTON AVE
Second Line :
City : SAGINAW
State : MI
Zip : 48602-5303
Country : US
Telephone Number : 989-746-7869
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2020
Last Update Date : 09/21/2021

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Directions to “ KELLY ELLIS NURSE PRACTITIONER” Practice Location

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