Provider Demographics
NPI:1336691245
Name:FULLY, ELVERL (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:ELVERL
Middle Name:
Last Name:FULLY
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 GRANT RD APT 4203
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4038
Mailing Address - Country:US
Mailing Address - Phone:346-308-0542
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DRIVE, SUITE 400
Practice Address - Street 2:THE ELLISON'S NURSING GROUP, LLC
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:267-513-1995
Practice Address - Fax:267-513-1729
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX989315163W00000X
PAPN303491164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse