Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 21234 | TN |
NPI | 1023560406 |
---|---|
Provider Name | Ms. Liza Catherine Ellis |
First Address | Nashville, TN 37205-2245 |
Second Address | Nashville, TN 37205-2013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2016 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q026397 | (05) | TN |