Individual
MRS. SHONTA ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
130 LAKE VALLEY DR, MAUMELLE, AR 72113-5939
(501) 766-1884
Mailing address
130 LAKE VALLEY DR, MAUMELLE, AR 72113-5939
(501) 766-1884
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
S002325
AR
364SG0600X
Gerontology Clinical Nurse Specialist
S002325
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S002325
CNS
AR
Enumeration date
09/24/2018
Last updated
09/24/2018
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