Provider Demographics
NPI:1356508691
Name:ELLISON, DEBORAH ANN (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:ELLISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1837
Mailing Address - Country:US
Mailing Address - Phone:860-659-2951
Mailing Address - Fax:860-659-2951
Practice Address - Street 1:10 PROGRESS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6216
Practice Address - Country:US
Practice Address - Phone:203-538-8004
Practice Address - Fax:203-926-0594
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily