Provider Demographics
NPI:1548744576
Name:VIG, ELLEN S
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:VIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KOHLRAUSCH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-1451
Mailing Address - Country:US
Mailing Address - Phone:978-944-3519
Mailing Address - Fax:
Practice Address - Street 1:8 KOHLRAUSCH AVE
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-1451
Practice Address - Country:US
Practice Address - Phone:978-944-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284655163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health