Provider Demographics
NPI:1407326986
Name:ATKINS, ELLEN PHA (LPN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PHA
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 MONROE AVE NW SUITE 140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505
Mailing Address - Country:US
Mailing Address - Phone:616-458-9520
Mailing Address - Fax:
Practice Address - Street 1:513 HENRY AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5522
Practice Address - Country:US
Practice Address - Phone:616-458-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator