| NPI | 1992253751 |
|---|---|
| Former Name | NICOLE LYNN ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21633) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 181828) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |