Provider Demographics
NPI:1689313348
Name:ELLZEY, RITA G (LPN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:G
Last Name:ELLZEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 HIGHWAY 1554
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-9243
Mailing Address - Country:US
Mailing Address - Phone:270-724-4254
Mailing Address - Fax:
Practice Address - Street 1:1143 23RD ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2562
Practice Address - Country:US
Practice Address - Phone:812-547-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2023710164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse