Individual
AMBER ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12701 US 70W, CLAYTON, NC 27520-2195
(919) 235-1968
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5012261
NC
363LF0000X
Family Nurse Practitioner
Primary
5012261
NC
363LF0000X
Family Nurse Practitioner
F06190711
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750940847
—
NC
Enumeration date
06/11/2019
Last updated
12/05/2022
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