Basic Information
| Provider Information | |||||||||
| NPI: | 1669693495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLISON | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 946 W. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | REDKEY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653693061 | ||||||||
| FaxNumber: | 7653693061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD. SUITE 240 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING, | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108341122 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 27032165A | IN | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.