Provider Demographics
NPI:1538676655
Name:ELLIS-NEMBHARD, PAULETTE
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:
Last Name:ELLIS-NEMBHARD
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 1:319 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3408
Mailing Address - Country:US
Mailing Address - Phone:617-394-7702
Mailing Address - Fax:
Practice Address - Street 1:319 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3408
Practice Address - Country:US
Practice Address - Phone:617-394-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN273439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse