Provider Demographics
NPI:1285224477
Name:ELLIS, APRIL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27930 N 93RD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5476
Mailing Address - Country:US
Mailing Address - Phone:480-600-8472
Mailing Address - Fax:
Practice Address - Street 1:16841 N 31ST AVE STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3080
Practice Address - Country:US
Practice Address - Phone:602-857-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN197177163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty