| NPI | 1245875012 |
|---|---|
| Former Name | OMEGA DALE ELLISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN307749) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: AL 1-173540) |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2023-03-18 |