Organization
DAN ELLIS GNP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN ELLIS (PRESIDENT)
(601) 636-0097
Entity
Organization
Contact information
Practice address
703B FARMER ST, PORT GIBSON, MS 39150-2319
(601) 529-2871
(601) 629-9969
Mailing address
PO BOX 215, UTICA, MS 39175-0215
(601) 529-2871
(601) 629-9969
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R826981
MS
Other
Enumeration date
10/04/2012
Last updated
12/26/2012
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