Individual
JESSICA ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.M
Contact information
Practice address
2525 E BROADWAY ST, STE 204, HELENA, MT 59601-8049
(406) 457-4366
(406) 457-4367
Mailing address
227 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 720-7733
(678) 493-9875
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
—
—
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
326666
GEORGIA LICENSE
GA
01
—
39957
STATE LICENSE NUMBER
MT
Enumeration date
03/08/2011
Last updated
10/21/2021
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