Individual
AQUANITA SHERETTA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
808 20TH ST, PHENIX CITY, AL 36867-4525
(706) 302-9291
Mailing address
1007 SAMFORD CT APT B, OPELIKA, AL 36801-9782
(706) 302-9291
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
3747A0650X
Attendant Care Provider
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
07/01/2024
Last updated
07/11/2024
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