Individual
PATRICIA JUNE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, PHD
Contact information
Practice address
1765 GOLDEN PL, MONDAMIN, IA 51557-4054
(402) 713-7106
Mailing address
1765 GOLDEN PL, MONDAMIN, IA 51557-4054
(402) 713-7106
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
B128724
IA
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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