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Individual

KATIE JO ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
730 W MARKET ST, LIMA, OH 45801-4602
(419) 227-3361
(419) 226-9826
Mailing address
216 E LIMA ST, FOREST, OH 45843-1118
(419) 273-2553
(419) 273-3337

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50001778
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00126759
MEDICARE RR
OH
Enumeration date
06/05/2006
Last updated
01/25/2022
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