Provider Demographics
NPI:1255320040
Name:ELLIS, JANE L (RN, MSN, NP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:L
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 STEPENDALE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4923
Mailing Address - Country:US
Mailing Address - Phone:281-578-9296
Mailing Address - Fax:
Practice Address - Street 1:21700 KINGSLAND BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2513
Practice Address - Country:US
Practice Address - Phone:281-398-8639
Practice Address - Fax:281-398-5019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236322363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health