Provider Demographics
NPI:1699830166
Name:ELLSWORTH, JUNE A (MED ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:A
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:MED ARNP
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:A
Other - Last Name:SABLESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-357-3565
Mailing Address - Fax:603-352-4337
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-357-3565
Practice Address - Fax:603-352-4337
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0271892308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
YGG0012345678OtherANTHEM BCBS
NHYGG0012345678Medicaid