Provider Demographics
NPI:1710990783
Name:ELLES-BORRSON, LISA G (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:G
Last Name:ELLES-BORRSON
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2766 OBERHELMAN RD
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-2017
Mailing Address - Country:US
Mailing Address - Phone:314-703-7152
Mailing Address - Fax:
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-1222
Practice Address - Fax:314-842-9952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO092981363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health