Provider Demographics
NPI:1679592299
Name:ELLIS, KATHERYN WILLINGHAM (RN, BSN,MSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:WILLINGHAM
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RN, BSN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41 BOX 41
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:GB
Mailing Address - Phone:01144184-282-9772
Mailing Address - Fax:
Practice Address - Street 1:48 MDG SGOBP
Practice Address - Street 2:UNIT 5210 BOX 230
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:GB
Practice Address - Phone:01144163-852-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC145474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse