Individual
ELLIE MARIE FAXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1499 N ROBBERSON AVE STE K500, SPRINGFIELD, MO 65802-1979
(417) 269-2667
(417) 269-2668
Mailing address
343 S FARM ROAD 97, SPRINGFIELD, MO 65802-9270
(970) 818-6938
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/26/2025
Last updated
08/05/2025
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