Provider Demographics
NPI:1770504805
Name:ELLISON, GAIL M (CFNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:ELLISON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:CLOUDCROFT
Mailing Address - State:NM
Mailing Address - Zip Code:88317-0013
Mailing Address - Country:US
Mailing Address - Phone:575-682-3309
Mailing Address - Fax:575-682-3649
Practice Address - Street 1:93 LITTLE GLORIETTA
Practice Address - Street 2:
Practice Address - City:CLOUDCROFT
Practice Address - State:NM
Practice Address - Zip Code:88317-8831
Practice Address - Country:US
Practice Address - Phone:575-682-3309
Practice Address - Fax:575-682-3649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily