Individual
KIMBERLY ELIZABETH ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-7355
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-7355
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP007021B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1310182
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/17/2006
Last updated
01/23/2013
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