Individual
NORA DENISE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
34406 N 27TH DR, BLDG 6, STE 100, PHOENIX, AZ 85085-6082
(623) 215-9951
(480) 350-7540
Mailing address
21001 N TATUM BLVD, STE 1630-156, PHOENIX, AZ 85050-4206
(623) 215-9951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3675
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z170156
MEDICARE PTAN
AZ
Enumeration date
09/04/2007
Last updated
11/03/2014
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