MEDICARE: MS. ELLEN E TREADWAY 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
1	363L00000X	Nurse Practitioner	AP139519	TX
2	363LF0000X	Family Nurse Practitioner	AP139519	TX

General Provider Information

NPI Number	:	1871052068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN E TREADWAY FNP-C

Provider Business Mailing Address
First Line	:	8425 MANION DR
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-3926
Country	:	US
Telephone Number	:	281-386-6730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2194 EASTEX FWY STE B
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77703-4981
Country	:	US
Telephone Number	:	409-899-2750
Fax Number	:	409-899-2757

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	02/01/2024

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Directions to “ MS. ELLEN E TREADWAY FNP-C” Practice Location

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