Individual
LAWANDA NICOLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
531 MS-23, TAYLORSVILLE, MS 39168
(601) 785-9580
Mailing address
531 MS-28, TAYLORSVILLE, MS 39168-5791
(601) 785-9580
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
901770
MS
390200000X
Student in an Organized Health Care Education/Training Program
Primary
901770
MS
Other
Enumeration date
09/02/2020
Last updated
11/10/2022
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