Individual
MARY ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3570 FOREST LAKE DR, UNIONTOWN, OH 44685-8105
(720) 200-2825
Mailing address
3241 MIDDLEBORO WAY, DUBLIN, OH 43017-1728
(614) 791-1650
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
611718
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAE2015
FFM UID
OH
01
—
ME2015
MLN UID
OH
Enumeration date
12/29/2014
Last updated
12/29/2014
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