| NPI | 1578661120 |
|---|---|
| Former Name | ELLEN M MATTINGLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 1631502) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3000593) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-05-21 |