Individual
HANNAH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
853 N CHURCH ST STE 700, SPARTANBURG, SC 29303-3003
(864) 560-6164
(864) 560-7092
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20822
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4391
—
SC
01
—
SCA1613365
MEDICARE PTAN
SC
Enumeration date
03/06/2017
Last updated
05/15/2017
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