| NPI | 1083255343 |
|---|---|
| Other Name | LISA ANNETTE ELLINGWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.020407) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.385774) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2024-04-22 |