Individual
ELLEN MCKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
(209) 576-3971
Mailing address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15301
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
GROUP PTAN
—
Enumeration date
12/11/2006
Last updated
02/01/2012
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