Individual
KATHERINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2016 1ST AVE, SUMMERVILLE, SC 29486-0408
(843) 432-3109
Mailing address
2016 1ST AVE, SUMMERVILLE, SC 29486-0408
(843) 432-3109
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
22035
SC
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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