Individual
ANDREA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4144 DEL ROSA DR, JACKSON, MS 39206-4732
(601) 572-5631
Mailing address
4144 DEL ROSA DR, JACKSON, MS 39206-4732
(601) 572-5631
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
07/29/2021
Last updated
07/29/2021
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