Individual
MRS. TRACI EILEEN EVANS-ELLACOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
125 E BROAD ST, SUITE 305, ELYRIA, OH 44035-6400
(440) 414-9100
(440) 322-3454
Mailing address
29325 HEALTH CAMPUS DR, SUITE 3, WESTLAKE, OH 44145-8201
(440) 414-9412
(440) 414-9059
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-06543
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342754
ANTHEM
OH
05
—
2284004
—
OH
01
—
500022799
RAILROAD MEDICARE
—
Enumeration date
01/26/2006
Last updated
03/03/2011
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