Provider Demographics
NPI:1891043071
Name:TEAL, ELLEN JEAN (APN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JEAN
Last Name:TEAL
Suffix:
Gender:F
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:JEAN
Other - Last Name:ONYETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3211 N NORTHHILLS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4007
Mailing Address - Country:US
Mailing Address - Phone:479-571-4338
Mailing Address - Fax:
Practice Address - Street 1:3211 N NORTHHILLS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4007
Practice Address - Country:US
Practice Address - Phone:479-571-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily