Individual
MRS. RACHEL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
1533 KILMER LN, NORFOLK, VA 23502-1809
(585) 329-9409
Mailing address
1533 KILMER LN, NORFOLK, VA 23502-1809
(585) 329-9409
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0126001457
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/14/2017
Last updated
12/07/2020
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