Individual
MRS. THERESA LYNN ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 W JEFFERSON ST, WARSAW, MO 65355-3471
(816) 898-1306
Mailing address
305 W JEFFERSON ST, WARSAW, MO 65355-3471
(816) 898-1306
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
MO
Other
Enumeration date
02/27/2025
Last updated
02/27/2025
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