Provider Demographics
NPI:1225225618
Name:ELLIS, ASHLEY RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENEE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 N BEN WILSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-7462
Mailing Address - Country:US
Mailing Address - Phone:361-655-8854
Mailing Address - Fax:
Practice Address - Street 1:1903 N BEN WILSON ST APT 1
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-7462
Practice Address - Country:US
Practice Address - Phone:361-655-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206584164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse