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NPI Code Detail

MEDICARE: EARNESTINE ELLIS APN

MEDICARE: EARNESTINE ELLIS APN
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
1363LX0001XObstetrics & Gynecology Nurse PractitionerAPN00065NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992778476
Entity Type Code : Individual
Provider Name (Legal Business Name) : EARNESTINE ELLIS APN
Provider Business Mailing Address
First Line : PO BOX 15645
Second Line :
City : LAS VEGAS
State : NV
Zip : 89114-5645
Country : US
Telephone Number : 702-750-3900
Fax Number : 702-750-3725
Provider Business Practice Location Address
First Line : 7061 GRAND MONTECITO PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-0287
Country : US
Telephone Number : 702-750-3900
Fax Number : 702-750-3725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 02/14/2014

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Directions to “ EARNESTINE ELLIS APN” Practice Location

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