Individual
ELLIS TRAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
CCHW
Contact information
Practice address
1348 BAINBRIDGE ST, PHILADELPHIA, PA 19147-1810
(215) 563-0658
(877) 316-4122
Mailing address
1348 BAINBRIDGE ST, PHILADELPHIA, PA 19147-1810
(215) 563-0658
(877) 316-4122
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
20215
PA
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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