Provider Demographics
NPI:1114245362
Name:SCARLETT, ELLEN-ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN-ELIZABETH
Middle Name:
Last Name:SCARLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ELLEN-ELIZABETH
Other - Middle Name:
Other - Last Name:SCARLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4333 W ST JOE HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4100
Mailing Address - Country:US
Mailing Address - Phone:404-803-7987
Mailing Address - Fax:
Practice Address - Street 1:4333 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4100
Practice Address - Country:US
Practice Address - Phone:404-803-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4704277189363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology