Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N2486 | TX |
Y | 2080P0208X | Pediatric Infectious Diseases | N2486 | TX |
NPI | 1376729897 |
---|---|
Provider Name | Dr. Misti G. Ellsworth |
First Address | Houston, TX 77030-1501 |
Second Address | Houston, TX 77030-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 29/04/2020 |