Individual
ELLISON AMY EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
262 E FRANCES LN, GILBERT, AZ 85295-1975
(480) 278-6954
Mailing address
262 E FRANCES LN, GILBERT, AZ 85295-1975
(480) 278-6954
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
220547
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220547
CASH PAY- MEDICAL SPA AND BASIC DERMATOLOGY
AZ
Enumeration date
04/13/2019
Last updated
04/13/2019
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