Provider Demographics
NPI:1861202533
Name:ELLERY, JONATHAN LEE I
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LEE
Last Name:ELLERY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RIVERBOAT ROW APT 414
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-4546
Mailing Address - Country:US
Mailing Address - Phone:513-546-2679
Mailing Address - Fax:
Practice Address - Street 1:1551 W NORTH BEND RD APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-7504
Practice Address - Country:US
Practice Address - Phone:513-546-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health