Individual
MRS. TARA LYNN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
23 HUSKY LANE, MALONE, NY 12953
(518) 483-5230
Mailing address
530 PORTER RD, MALONE, NY 12953-3804
15184835230
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
591941
NY
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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