Provider Demographics
NPI:1619377124
Name:ELLIS, NATARSHA NECOLE
Entity Type:Individual
Prefix:
First Name:NATARSHA
Middle Name:NECOLE
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 1:3360 CLEARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4572
Mailing Address - Country:US
Mailing Address - Phone:281-968-7162
Mailing Address - Fax:281-968-7162
Practice Address - Street 1:3360 CLEARWOOD CIR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4572
Practice Address - Country:US
Practice Address - Phone:281-968-7162
Practice Address - Fax:281-968-7162
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015710253Z00000X, 372500000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide