Provider Demographics
NPI:1700385051
Name:ELLIS, LAURA C (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 EVANS CITY RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:16037-9116
Mailing Address - Country:US
Mailing Address - Phone:724-453-4335
Mailing Address - Fax:
Practice Address - Street 1:2469 EVANS CITY RD.
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:PA
Practice Address - Zip Code:16037-6811
Practice Address - Country:US
Practice Address - Phone:724-453-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist