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Individual

MRS. HELEN D EZELLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN, BA

Contact information

Practice address
1612 TENNESSEE AVE, LYNN HAVEN, FL 32444-3653
(850) 248-0030
Mailing address
1612 TENNESSEE AVE, LYNN HAVEN, FL 32444-3653
(850) 248-0030

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
001768700
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001768700
FL
Enumeration date
03/29/2011
Last updated
03/29/2011
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