MEDICARE: LOUISA ELLISON BSN, RN

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	163WM0705X	Medical-Surgical Registered Nurse	0001285902	VA

General Provider Information

NPI Number	:	1912860669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISA ELLISON BSN, RN

Provider Business Mailing Address
First Line	:	1412 GRANADA CT
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4529
Country	:	US
Telephone Number	:	757-338-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 COLISEUM DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5963
Country	:	US
Telephone Number	:	757-736-1000
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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