Individual
MRS. LINDA Y ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3950 17TH ST, SUITE A, BAKER CITY, OR 97814-1300
(541) 523-1001
(541) 523-1152
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
097006942N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276275
—
OR
01
—
383852
MEDICARE PART A
—
Enumeration date
10/10/2005
Last updated
07/31/2013
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