Individual
MS. MARILYN E ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
400 VETERANS AVE, BILOXI, MS 39531-2410
(228) 523-5000
(228) 523-4322
Mailing address
14256 CARRIAGE CIR, GULFPORT, MS 39503-5040
(228) 832-1926
(228) 523-4322
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R566624
MS
363LA2200X
Adult Health Nurse Practitioner
RN 028339 APO1951
LA
Other
Enumeration date
06/16/2006
Last updated
07/08/2007
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