Provider Demographics
NPI:1437810025
Name:ELLIS, DANIELLE LOUISE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LOUISE
Last Name:ELLIS
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 1:704 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033-1562
Mailing Address - Country:US
Mailing Address - Phone:618-795-3617
Mailing Address - Fax:
Practice Address - Street 1:704 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-1562
Practice Address - Country:US
Practice Address - Phone:618-795-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide