Provider Demographics
NPI:1629504386
Name:ELLER, PATRICIA JANE (CMF)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANE
Last Name:ELLER
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7371
Mailing Address - Country:US
Mailing Address - Phone:910-658-7656
Mailing Address - Fax:
Practice Address - Street 1:106 PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4027
Practice Address - Country:US
Practice Address - Phone:919-775-2001
Practice Address - Fax:919-776-8122
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment