Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 9078 | OH |
NPI | 1629202320 |
---|---|
Provider Name | Ms. Ardith K Ellis |
First Address | Oberlin, OH 44074-1182 |
Second Address | Oberlin, OH 44074-1182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 08/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34192227400 | WORKERS COMPENSATION (01) | OH |