Individual
ELLISA ANNE BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
14828 GREYHOUND CT STE 100, CARMEL, IN 46032-5016
(317) 688-5220
(317) 688-5220
Mailing address
14828 GREYHOUND CT STE 100, CARMEL, IN 46032-5016
(317) 688-5220
(317) 688-5220
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28241444A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71015564A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300097290
—
IN
Enumeration date
08/29/2024
Last updated
05/16/2025
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