Provider Demographics
NPI:1144573379
Name:ELLIS, PAMELA WHITE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:WHITE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FRANCIS MARION LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4227
Mailing Address - Country:US
Mailing Address - Phone:276-781-7450
Mailing Address - Fax:276-781-7455
Practice Address - Street 1:201 FRANCIS MARION LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4227
Practice Address - Country:US
Practice Address - Phone:276-781-7450
Practice Address - Fax:276-781-7455
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024073911363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health