Individual
PAULA LOU ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
114 N MAIN ST, ITHACA, MI 48847-1132
(989) 875-4166
(989) 875-5168
Mailing address
406 E ELM ST, CARSON CITY, MI 48811-9693
(989) 584-3131
(989) 584-6734
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704187187
MI
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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