Provider Demographics
NPI:1659783884
Name:DUELL, ELLEN O
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:O
Last Name:DUELL
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 1:500 BLUE HILLS AVE/ WOUND CARE CENTER
Mailing Address - Street 2:SAINT FRANCIS MEDICAL GROUP, INC
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1500
Mailing Address - Country:US
Mailing Address - Phone:860-714-3010
Mailing Address - Fax:
Practice Address - Street 1:500 BLUE HILLS AVE/ WOUND CARE CENTER
Practice Address - Street 2:ST. FRANCIS MEDICAL GROUP, INC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1500
Practice Address - Country:US
Practice Address - Phone:860-714-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001716363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health