| NPI | 1396149530 |
|---|---|
| Former Name | CRYSTLE DANIELA ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL PA.1004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1004) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2025-05-09 |