Provider Demographics
NPI:1487229472
Name:ELLEN VITAL SOLUTION LLC
Entity Type:Organization
Organization Name:ELLEN VITAL SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:346-313-0150
Mailing Address - Street 1:9711 S MASON RD STE 125-650
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7167
Mailing Address - Country:US
Mailing Address - Phone:281-941-2887
Mailing Address - Fax:281-816-1001
Practice Address - Street 1:9711 S MASON RD STE 125-650
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7167
Practice Address - Country:US
Practice Address - Phone:281-941-2887
Practice Address - Fax:281-816-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care