Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024093568 | VA |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 5008719 | NC |
NPI | 1144431982 |
---|---|
Provider Name | Ellen C. Ford |
First Address | Greenville, NC 27834-2818 |
Second Address | Greenville, NC 27834-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 28/12/2021 |