Provider Demographics
NPI:1639889926
Name:ELLIS, AMBER (CNA, GNA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CNA, GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11886 WHITE PINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:240-385-3270
Mailing Address - Fax:
Practice Address - Street 1:11886 WHITE PINE DRIVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:240-385-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101711376K00000X
PA20058087376K00000X
MDA00197146376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide