Individual
CARISSA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
74 MILL DR, MASTIC BEACH, NY 11951-1403
(631) 578-5758
Mailing address
PO BOX 5582, BAY SHORE, NY 11706-0411
(631) 578-5758
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
22 717140
NY
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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