Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | MS |
NPI | 1043363856 |
---|---|
Provider Name | Nancy Ellis |
First Address | Meridian, MS 39301-2634 |
Second Address | Meridian, MS 39301-2634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 09/07/2007 |