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Individual

SHANNA ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
5405 RURAL WAY, LOUISVILLE, KY 40218-4247
(502) 741-0193
Mailing address
5405 RURAL WAY, LOUISVILLE, KY 40218-4247

Taxonomy

Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
1119268
KY

Other

Enumeration date
01/07/2021
Last updated
01/07/2021
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