Individual
CAROL A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP30007996
WA
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-825A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005325
REGENCE BLUESHIELD
ID
01
—
0226013
LABOR & INDUSTRIES
WA
01
—
1341036
DMERC
—
01
—
807875800
HEATHLY CONNECTIONS
ID
05
—
807875800
—
ID
05
—
9654294
—
WA
01
—
NPZA5
BLUE CROSS
ID
Enumeration date
08/28/2007
Last updated
03/08/2016
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