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Individual

ERICA LEIGH ELLICOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
801 W C ST, MC COOK, NE 69001-3591
(308) 777-2476
(308) 223-5752
Mailing address
136 W 12TH ST, IMPERIAL, NE 69033-3112
(308) 883-0658

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1908
NE

Other

Enumeration date
03/16/2015
Last updated
02/12/2024
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