Provider Demographics
NPI:1780191155
Name:MCCOLLUM, ELLEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ELLEN M PLANT, RN
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-791-2540
Mailing Address - Fax:717-791-2549
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103473515Medicaid