Provider Demographics
NPI:1093984205
Name:BARTLE, ELLEN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:BARTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 WINTON RD S
Mailing Address - Street 2:BLDG. 4, SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3960
Mailing Address - Country:US
Mailing Address - Phone:585-473-0495
Mailing Address - Fax:585-442-0750
Practice Address - Street 1:1870 WINTON RD S
Practice Address - Street 2:BLDG. 4, SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3960
Practice Address - Country:US
Practice Address - Phone:585-473-0495
Practice Address - Fax:585-442-0750
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333351-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02172609Medicaid
NY02172609Medicaid