Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 356 | CA |
NPI | 1023357282 |
---|---|
Provider Name | Courtney Kaye Ellis |
First Address | Aliso Viejo, CA 92656-4218 |
Second Address | Aliso Viejo, CA 92656-4218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2013 |
Last Update Date | 07/02/2013 |