Individual
MISHELL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2244 EXECUTIVE DR, HAMPTON, VA 23666-2430
(757) 827-1001
Mailing address
856 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601-1318
(757) 316-5800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024174257
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024174257
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024174257
VIRGINIA NURSE PRACTITIONER LICENSE
VA
01
—
RN234444
STATE LICENSE
GA
Enumeration date
10/30/2013
Last updated
08/23/2023
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