Provider Demographics
NPI:1124357389
Name:ELLIS, FAITH ISABELLA (CD(DONA))
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ISABELLA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 WHITEFERN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1649
Mailing Address - Country:US
Mailing Address - Phone:817-681-1493
Mailing Address - Fax:
Practice Address - Street 1:3737 WHITEFERN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1649
Practice Address - Country:US
Practice Address - Phone:817-681-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula