Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | N-5613 | AR |
NPI | 1023108685 |
---|---|
Provider Name | Eileen Ellis |
First Address | Little Rock, AR 72202-3510 |
Second Address | Little Rock, AR 72202-3510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C68217 | (02) |