MEDICARE: MR. SHAWN ARCHIE 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
1	363LA2100X	Acute Care Nurse Practitioner	4704362684	MI

General Provider Information

NPI Number	:	1932908431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN ARCHIE ELLIS NP

Provider Business Mailing Address
First Line	:	1780 E PARNALL RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-7136
Country	:	US
Telephone Number	:	517-780-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 E PARNALL RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-7136
Country	:	US
Telephone Number	:	517-780-6357
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

Similar Medicare Providers

1013586825 — XINLEI MILLER DMD
Practice Location Address:

1780 E PARNALL RD
JACKSON, MI
49201-7136

Practice Phone: 517-780-6729
Practice Fax:

1376732081 — NUMA P. CABRERA M.D.
Practice Location Address:

1780 E PARNALL RD
JACKSON, MI
49201-7136

Practice Phone: 517-780-6722
Practice Fax:

1265729883 — PHS OF MICHIGAN PC
Practice Location Address:

1780 E PARNALL RD , PARNALL CORRECTION FACILITY- MEDICAL CLINIC
JACKSON, MI
49201-7136

Practice Phone: 517-780-6393
Practice Fax:

1174810741 — SAJJAD HUSSAIN MD
Practice Location Address:

1780 E PARNALL RD , PARNALL CORRECTION FACILITY - HEALTH CARE CENTER
JACKSON, MI
49201-7136

Practice Phone: 517-780-6393
Practice Fax:

1437551595 — MISS PRIMA MARDHATILLAH MUZIRMAN NP
Practice Location Address:

1780 E PARNALL RD
JACKSON, MI
49201-7136

Practice Phone: 517-780-6004
Practice Fax:

1548359250 — MS. MARIA MARISSA DAVIS
Practice Location Address:

205 N EAST AVE
JACKSON, MI
49201-1753

Practice Phone: 517-205-7364
Practice Fax:

Directions to “ MR. SHAWN ARCHIE ELLIS NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.