Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 233757 | MA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 233757 | MA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 233757 | MA |
NPI | 1003913567 |
---|---|
Provider Name | Ms. Kerri A Ellis |
First Address | Upton, MA 01568-1309 |
Second Address | Upton, MA 01568-1309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110073123A | (05) | MA |
Q75266 | (02) |