Provider Demographics
NPI:1659325496
Name:CHURCHILL, ELLA CHILDS (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:CHILDS
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 RUSS AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2998
Mailing Address - Country:US
Mailing Address - Phone:828-452-2230
Mailing Address - Fax:
Practice Address - Street 1:773 RUSS AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2998
Practice Address - Country:US
Practice Address - Phone:828-452-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201836363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000994Medicaid
S27277Medicare UPIN
NC2592019Medicare ID - Type Unspecified