Individual
CAROLYN M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4498 1ST AVE, EVANSVILLE, IN 47710-3622
(812) 436-7280
(812) 436-7290
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 436-7280
(812) 436-7290
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002609A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200829210
—
IN
Enumeration date
07/31/2006
Last updated
09/15/2014
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