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Individual
MRS. ELLEN LAVERA QUALLS
Active
Individual
MRS. ELLEN LAVERA QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
A03179
AR
364SA2100X
Acute Care Clinical Nurse Specialist
A03179
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180502758
—
AR
01
—
5R233
BCBS
AR
01
—
A03179
APN LICENSE A03179
AR
Enumeration date
12/05/2008
Last updated
03/25/2024
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