Individual
MICHELLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC
Contact information
Practice address
1290 TREMONT ST, ROXBURY, MA 02120-3432
(617) 989-3289
(617) 989-3125
Mailing address
1290 TREMONT ST, ROXBURY, MA 02120-3432
(617) 989-3289
(617) 989-3125
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
702696
NY
163W00000X
Registered Nurse
RN2339531
MA
363LF0000X
Family Nurse Practitioner
33341477
NY
363LF0000X
Family Nurse Practitioner
Primary
RN2339531
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
07/11/2016
Last updated
07/26/2021
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