Provider Demographics
NPI:1821181470
Name:DRURY, ELLEN MARY (CNM, RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:DRURY
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 NINTH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:785 18TH STREET
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-822-2481
Practice Address - Fax:707-822-3656
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW0056367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife