Provider Demographics
NPI:1265470363
Name:ELLINGTON, ERIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2514
Mailing Address - Country:US
Mailing Address - Phone:520-876-1800
Mailing Address - Fax:
Practice Address - Street 1:210 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2514
Practice Address - Country:US
Practice Address - Phone:520-876-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710702363LP0808X
AZAP3402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174209001Medicaid
TX8D6836Medicare ID - Type UnspecifiedMEDICARE NO
TX174209001Medicaid