Provider Demographics
NPI:1508155706
Name:EZELLL, HELEN D (LPN, BA)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:D
Last Name:EZELLL
Suffix:
Gender:F
Credentials:LPN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3653
Mailing Address - Country:US
Mailing Address - Phone:850-248-0030
Mailing Address - Fax:
Practice Address - Street 1:1612 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3653
Practice Address - Country:US
Practice Address - Phone:850-248-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001768700222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001768700Medicaid