Provider Demographics
NPI:1033203401
Name:CALL, ELLEN W (CFNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:W
Last Name:CALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 639
Mailing Address - Street 2:19021 US HIGHWAY 285
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-0639
Mailing Address - Country:US
Mailing Address - Phone:719-274-6000
Mailing Address - Fax:719-274-6038
Practice Address - Street 1:19021 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-0639
Practice Address - Country:US
Practice Address - Phone:719-274-6000
Practice Address - Fax:719-274-6038
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22496207Y00000X
NMCNP00382363L00000X
CO20016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z5375Medicaid
CO78221030Medicaid
NM000Z5375Medicaid
343506603Medicare PIN