Provider Demographics
NPI:1326360603
Name:TIZZANO, ELLEN M
Entity Type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:M
Last Name:TIZZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NAUTICAL WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:44077-6912
Mailing Address - Country:US
Mailing Address - Phone:440-521-0169
Mailing Address - Fax:
Practice Address - Street 1:105 NAUTICAL WAY
Practice Address - Street 2:
Practice Address - City:FAIRPORT HARBOR
Practice Address - State:OH
Practice Address - Zip Code:44077-6912
Practice Address - Country:US
Practice Address - Phone:440-521-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 233194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse