Individual
TANYA SHAWN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6320 W UNION HILLS DR STE 2800B, GLENDALE, AZ 85308-1380
(623) 322-4991
(623) 322-9568
Mailing address
6320 W UNION HILLS DR STE 2800B, GLENDALE, AZ 85308-1380
(623) 322-4991
(623) 322-9568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26544
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0720030
BC/BS
AZ
Enumeration date
03/08/2006
Last updated
07/30/2019
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