Provider Demographics
NPI:1861913428
Name:ELY, ELYSSA MARIE (APRN)
Entity type:Individual
Prefix:MISS
First Name:ELYSSA
Middle Name:MARIE
Last Name:ELY
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:108 MAY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-7416
Mailing Address - Country:US
Mailing Address - Phone:978-460-2935
Mailing Address - Fax:
Practice Address - Street 1:330 CEDAR ST
Practice Address - Street 2:BB 114
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-785-4184
Practice Address - Fax:203-785-7068
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT10.09895163WN0300X
CT12.007063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology