Provider Demographics
NPI:1902388093
Name:ELLZEY, ANASTASIA (LVN)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ELLZEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 APOLLO RD APT 2018
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6409
Mailing Address - Country:US
Mailing Address - Phone:214-900-5538
Mailing Address - Fax:
Practice Address - Street 1:1730 APOLLO RD APT 2018
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6409
Practice Address - Country:US
Practice Address - Phone:214-900-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324374164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse