Provider Demographics
NPI:1164729505
Name:DERBY, ELLEN C (CD(DONA) CLC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:DERBY
Suffix:
Gender:F
Credentials:CD(DONA) CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1048
Mailing Address - Country:US
Mailing Address - Phone:315-462-3394
Mailing Address - Fax:
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1048
Practice Address - Country:US
Practice Address - Phone:315-462-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula