Individual
ELLEN LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
289 W HUNTINGTON DR STE 401, ARCADIA, CA 91007-3493
(626) 254-0074
(626) 254-0240
Mailing address
3452 E FOOTHILL BLVD STE 130, PASADENA, CA 91107-6006
(626) 793-2885
(626) 793-6262
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2020115166
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020115166
AMERICAN NURSES CREDENTIALING CENTER
CA
01
—
95016212
NURSE PRACTITIONER
CA
Enumeration date
11/10/2020
Last updated
01/05/2021
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