Provider Demographics
NPI:1861608952
Name:ELLIS, ELEANOR MARY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:MARY
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:31 SAWYER ST
Mailing Address - Street 2:1L
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2241
Mailing Address - Country:US
Mailing Address - Phone:978-794-0920
Mailing Address - Fax:
Practice Address - Street 1:71 WILDER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3097
Practice Address - Country:US
Practice Address - Phone:978-934-4991
Practice Address - Fax:978-934-3080
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA75424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily