| NPI | 1649226556 |
|---|---|
| Former Name | DIANE ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3008600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71000506A) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-03-09 |