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Individual
MATTHEW ELLAM
Active
Individual
MATTHEW ELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2295977
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2295977
MA
Other
Enumeration date
02/19/2015
Last updated
03/05/2021
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