Individual
JUANITA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, PMHNP-BC
Contact information
Practice address
151 N MICHIGAN ST STE 224, TOLEDO, OH 43604-6941
(419) 963-4299
Mailing address
151 N MICHIGAN ST STE 224, TOLEDO, OH 43604-6941
(419) 963-4299
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN 139813-M-IV
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN.410281
OH
Other
Enumeration date
06/06/2013
Last updated
07/02/2024
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