Provider Demographics
NPI:1164187670
Name:ELLEN CARTY LLC
Entity Type:Organization
Organization Name:ELLEN CARTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:508-280-9539
Mailing Address - Street 1:300 BUCK ISLAND RD APT 3I
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2543
Mailing Address - Country:US
Mailing Address - Phone:508-280-9539
Mailing Address - Fax:
Practice Address - Street 1:300 BUCK ISLAND RD APT 3I
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2543
Practice Address - Country:US
Practice Address - Phone:508-280-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty