Provider Demographics
NPI:1306000310
Name:ELLIS, JARMAINE LEE (LPN)
Entity Type:Individual
Prefix:MR
First Name:JARMAINE
Middle Name:LEE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:JARMAINE
Other - Middle Name:LEE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4533 N 67TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:414-461-2977
Mailing Address - Fax:414-461-2977
Practice Address - Street 1:4533 N 67TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-461-2977
Practice Address - Fax:414-461-2977
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306353-031364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care