Provider Demographics
NPI:1245587930
Name:ELLIS, MELANIE A (ND)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8865
Mailing Address - Country:US
Mailing Address - Phone:307-527-5577
Mailing Address - Fax:307-527-5577
Practice Address - Street 1:20 CEDAR MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8865
Practice Address - Country:US
Practice Address - Phone:307-527-5577
Practice Address - Fax:307-527-5577
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1106175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath