Individual
SAMANTHA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
15420 N 32ND DR, PHOENIX, AZ 85053
(602) 866-1974
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP8278
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387005
—
AZ
Enumeration date
05/24/2016
Last updated
08/23/2019
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