| NPI | 1942641840 |
|---|---|
| Former Name | CANDICE DIANE ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71004660A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28170182A) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2021-02-11 |