Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 24459 | TN |
N | 363LA2100X | Nurse Practitioner - Acute Care | AP09247 | LA |
N | 363LA2100X | Nurse Practitioner - Acute Care | R898664 | MS |
NPI | 1013315464 |
---|---|
Provider Name | Marita Walton Ellis |
First Address | Nashville, TN 37203-6511 |
Second Address | Nashville, TN 37203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2014 |
Last Update Date | 22/01/2019 |