Provider Demographics
NPI:1548310873
Name:HOOD, ELLAN L (CNS)
Entity type:Individual
Prefix:
First Name:ELLAN
Middle Name:L
Last Name:HOOD
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-931-5227
Mailing Address - Fax:219-932-8455
Practice Address - Street 1:3229 BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1036
Practice Address - Country:US
Practice Address - Phone:219-887-4950
Practice Address - Fax:219-887-4955
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN70000196A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200850160Medicaid
INQ75333OtherUPIN
IN164210TMedicare PIN