Individual
AMANDA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1902 CENTRAL AVE, FAIRBANKS, AK 99709-4223
(907) 398-7297
Mailing address
PO BOX 80929, FAIRBANKS, AK 99708-0929
(907) 398-7297
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Enumeration date
08/13/2021
Last updated
08/18/2021
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