Provider Demographics
NPI:1902933997
Name:ELLIS, NORMA M (RNP)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:M
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2039
Mailing Address - Country:US
Mailing Address - Phone:718-933-2400
Mailing Address - Fax:718-367-8168
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:MMC SCHOOL HEALTH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-696-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner