Provider Demographics
NPI:1356680623
Name:ELLEN, DANI (NP)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:
Last Name:ELLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28953
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8953
Mailing Address - Country:US
Mailing Address - Phone:559-228-4298
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:722 MEDICAL CENTER DR E STE 105
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6810
Practice Address - Country:US
Practice Address - Phone:559-299-7700
Practice Address - Fax:559-224-3420
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9082363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology