Individual
SHANE P ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP ANP BC
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-7755
Mailing address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-7755
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R144232
MD
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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