Individual
ELLEN RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4525 MID RIVERS MALL DR STE 10, COTTLEVILLE, MO 63376-2820
(636) 229-3350
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6442
(636) 229-3350
(636) 229-3355
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
2005005840
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
2023033858
MO
Other
Enumeration date
07/27/2023
Last updated
08/31/2023
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