Individual
JENNIFER L ELLEGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
5200 HARROUN RD, SYLVANIA, OH 43560-2168
(419) 824-1952
(419) 824-1751
Mailing address
4841 MONROE ST, SUITE 103, TOLEDO, OH 43623-4385
(419) 471-0493
(419) 472-2772
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-002331
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-002331
PA LICENSE
OH
01
—
P00354306
RR MEDICARE
OH
Enumeration date
01/24/2006
Last updated
10/26/2007
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