Individual
AMANDA SUSAN ELLINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2770 3RD AVE STE 120, LAKE CHARLES, LA 70601-8994
(337) 494-4868
(337) 494-4870
Mailing address
P.O. BOX 122342 DEPT 2342, LAKE CHARLES, LA 70601
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
203251
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1099791
—
LA
01
—
MD.203251
STATE MEDICAL LICENSE
LA
Enumeration date
05/29/2007
Last updated
06/09/2022
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