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NPI Code Detail

MEDICARE: AMY ELLSWORTH

MEDICARE: AMY ELLSWORTH
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 Practitioner0024168309VA

General Provider Information

NPI Number : 1922332998
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELLSWORTH
Provider Business Mailing Address
First Line : 1751 E GARRY AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5814
Country : US
Telephone Number : 877-896-7350
Fax Number :
Provider Business Practice Location Address
First Line : 1751 E GARRY AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5814
Country : US
Telephone Number : 877-896-7350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2009
Last Update Date : 04/24/2019

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Directions to “ AMY ELLSWORTH ” Practice Location

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