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NPI Code Detail

MEDICARE: REBECCA ELLIS DNP, APRN, FNP-C

MEDICARE: REBECCA ELLIS DNP, APRN, FNP-C
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
1363LP2300XPrimary Care Nurse Practitioner214328OK

General Provider Information

NPI Number : 1861171894
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ELLIS DNP, APRN, FNP-C
Provider Business Mailing Address
First Line : 3122 WISTER RD
Second Line :
City : NORMAN
State : OK
Zip : 73069-6996
Country : US
Telephone Number : 817-691-8295
Fax Number :
Provider Business Practice Location Address
First Line : 5472 MAIN ST STE 101
Second Line :
City : DEL CITY
State : OK
Zip : 73115-5524
Country : US
Telephone Number : 405-622-3699
Fax Number : 405-585-0730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2023
Last Update Date : 07/17/2023

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