Provider Demographics
NPI:1770284879
Name:MITCHELL ELLSWORTH, ANN MARY (CNS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARY
Last Name:MITCHELL ELLSWORTH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 EL CAMINO REAL
Mailing Address - Street 2:SUITE 1199, SECOND FLOOR, OFFICE 216
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-206-0802
Mailing Address - Fax:
Practice Address - Street 1:180 EL CAMINO REAL
Practice Address - Street 2:SUITE 1199, SECOND FLOOR, OFFICE 216
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-206-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4685364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care