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NPI Code Detail

MEDICARE: MRS. LINDA Y ELLIS NP

MEDICARE: MRS. LINDA Y 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
1363LF0000XFamily Nurse Practitioner097006942N1OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1383852OTHERMEDICARE PART A

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841288339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDA Y ELLIS NP
Provider Business Mailing Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-381-2222
Fax Number :
Provider Business Practice Location Address
First Line : 3950 17TH ST
Second Line : SUITE A
City : BAKER CITY
State : OR
Zip : 97814-1300
Country : US
Telephone Number : 541-523-1001
Fax Number : 541-523-1152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/31/2013

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Directions to “ MRS. LINDA Y ELLIS NP” Practice Location

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