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Individual

JEAN MARIE LARAMORE ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
208 OLD MOCKSVILLE RD, STATESVILLE, NC 28625-1930
(704) 838-8210
(704) 838-8209
Mailing address
PO BOX 1845, STATESVILLE, NC 28687-1845
(704) 873-4277
(704) 873-4511

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103578
NC

Other

Enumeration date
07/22/2006
Last updated
07/08/2007
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