| NPI | 1962269118 |
|---|---|
| Former Name | JAYLYN DENISE ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NM S3-1615) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NM 1456) |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2025-01-23 |