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NPI Profile for TARA L ELLIS in MALONE, NY.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
School |
163WS0200X |
| NPI Number | 1003325424 |
|
| Status | Active | |
| Credentials | RN (Registered Nurse) | |
| Entity | Individual | |
| Enumeration date | 09/28/2017 | |
| Last updated | 09/28/2017 - About 9 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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TARA L ELLIS
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TARA L ELLIS, RN