Individual
MEGHAN MICHELLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP, CPMT
Contact information
Practice address
3819 6TH AVE, TACOMA, WA 98406-4903
(253) 686-1721
Mailing address
4611 N FRACE AVE, TACOMA, WA 98407-1213
(253) 686-1721
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA00021996
WA
Other
Enumeration date
01/18/2012
Last updated
01/18/2012
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