Individual
KATHLEEN DUNLEVY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
611 E DOUGLAS RD STE 207, MISHAWAKA, IN 46545-1465
(574) 335-6850
Mailing address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-8707
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10004107A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300080410
—
IN
Enumeration date
08/30/2023
Last updated
01/13/2026
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