Provider Demographics
NPI:1568696094
Name:ELLEN SPINNER LLC
Entity Type:Organization
Organization Name:ELLEN SPINNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:COLEEN
Authorized Official - Last Name:SPINNER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:937-834-5320
Mailing Address - Street 1:15 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-1106
Mailing Address - Country:US
Mailing Address - Phone:937-834-5320
Mailing Address - Fax:937-834-5322
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-1106
Practice Address - Country:US
Practice Address - Phone:937-834-5320
Practice Address - Fax:937-834-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04620363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668411Medicaid
OH2668411Medicaid