Provider Demographics
NPI:1225035223
Name:ELLIS, ANN WILSON (CNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:WILSON
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 PINE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2191
Mailing Address - Country:US
Mailing Address - Phone:513-936-9191
Mailing Address - Fax:513-936-0222
Practice Address - Street 1:8251 PINE RD
Practice Address - Street 2:STE 220
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2191
Practice Address - Country:US
Practice Address - Phone:513-936-9191
Practice Address - Fax:513-936-0222
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003153363L00000X
OHNP-5172363LA2100X
KY3153363LA2100X
OH05172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0369012OtherMEDICARE
OH2383344Medicaid
KY0562612OtherMEDICARE
KY78011780Medicaid
OH611300608060OtherCARESOURCE
OHSINP04272Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY0369012OtherMEDICARE
S89709Medicare UPIN
KYP400020302Medicare PIN
OHELNP04271Medicare PIN
OH2383344Medicaid
OHELNP04273Medicare PIN
KY0562612Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY0369012Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY0562612OtherMEDICARE
OHSINP04271Medicare ID - Type UnspecifiedMEDICARE NUMBER