Provider Demographics
NPI:1114780582
Name:MAHAFFIE, ELLA ANN
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:ANN
Last Name:MAHAFFIE
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 1:14344 CRAFTSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4039
Mailing Address - Country:US
Mailing Address - Phone:303-960-2858
Mailing Address - Fax:
Practice Address - Street 1:14344 CRAFTSMAN WAY
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-4039
Practice Address - Country:US
Practice Address - Phone:303-960-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach