Provider Demographics
NPI:1083295885
Name:ELLIS-PEARL, JOY M
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:ELLIS-PEARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2759
Mailing Address - Country:US
Mailing Address - Phone:216-389-2986
Mailing Address - Fax:
Practice Address - Street 1:158 LAURIE LN
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2759
Practice Address - Country:US
Practice Address - Phone:216-389-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion