Individual
AMY JENE ELLINGWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1630 LAFAYETTE RD STE 200, CRAWFORDSVILLE, IN 47933-1092
(765) 359-2230
(765) 359-2236
Mailing address
1040 SIERRA DR STE 400, GREENWOOD, IN 46143-7241
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2012011503
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71004165A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201115580
—
IN
Enumeration date
08/07/2012
Last updated
03/17/2021
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