Provider Demographics
NPI:1053329763
Name:ELLI, LEORA JANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LEORA
Middle Name:JANE
Last Name:ELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1459 POPLAR ESTATES PKWY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1840
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:901-577-7381
Practice Address - Street 1:MEMPHIS VA MEDICAL CENTER,
Practice Address - Street 2:1030 JEFFERSON AVE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2193
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7381
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant