Provider Demographics
NPI:1871843631
Name:WILSON ELLIS, JULIE KAYE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAYE
Last Name:WILSON ELLIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:KAYE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1508 HAVEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1563
Mailing Address - Country:US
Mailing Address - Phone:937-648-4743
Mailing Address - Fax:
Practice Address - Street 1:1508 HAVEN HILL DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1563
Practice Address - Country:US
Practice Address - Phone:937-648-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145983164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse