Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1698 | AZ |
NPI | 1063916104 |
---|---|
Provider Name | Dr. Erin Brett Ellis |
First Address | Gilbert, AZ 85298-4263 |
Second Address | Gilbert, AZ 85298-4263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 17/02/2021 |