Individual
RENEE M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 N 67TH AVE, GLENDALE, AZ 85301-8214
(623) 237-4610
Mailing address
5535 N 67TH AVE, GLENDALE, AZ 85301-8214
(623) 237-4610
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP030868
AZ
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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