Individual
MRS. AMANDA L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN.CNP
Contact information
Practice address
408 9TH ST SW, CANTON, OH 44707-4714
(330) 454-2000
Mailing address
408 9TH ST SW, CANTON, OH 44707-4714
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.025521
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0414147
—
OH
Enumeration date
12/06/2019
Last updated
01/19/2022
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