Individual
MRS. STEPHANIE M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 674-7546
(309) 282-0500
Mailing address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 674-7546
(309) 282-0500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Enumeration date
08/11/2010
Last updated
08/11/2010
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