Individual
MRS. AMBER NICOLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 S 4TH ST, CLINTON, OK 73601-2309
(405) 376-9980
Mailing address
1218 E HIGHLINE LN, MUSTANG, OK 73064-6406
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
91331
OK
363LF0000X
Family Nurse Practitioner
Primary
F10171219
OK
Other
Enumeration date
09/27/2018
Last updated
06/04/2020
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