Provider Demographics
NPI:1326297748
Name:ELLIS, JENINE M (RDMS)
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:M
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CENTRE GREEN WAY,
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5610
Mailing Address - Country:US
Mailing Address - Phone:919-228-6366
Mailing Address - Fax:
Practice Address - Street 1:1000 CENTRE GREEN WAY ,
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5610
Practice Address - Country:US
Practice Address - Phone:919-460-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00173112302471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography