Provider Demographics
NPI:1821773425
Name:ELLIS, DEBBIE LEIGH
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LEIGH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 E 59TH ST APT 2601
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7047
Mailing Address - Country:US
Mailing Address - Phone:918-361-8772
Mailing Address - Fax:
Practice Address - Street 1:2118 E 59TH ST # 2601
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7004
Practice Address - Country:US
Practice Address - Phone:918-430-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty