Provider Demographics
NPI:1326274358
Name:PLACE, ELLEN LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LOUISE
Last Name:PLACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 SAN RAMON VALLEY BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1661
Mailing Address - Country:US
Mailing Address - Phone:925-820-1866
Mailing Address - Fax:
Practice Address - Street 1:2551 SAN RAMON VALLEY BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1661
Practice Address - Country:US
Practice Address - Phone:925-820-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse