Provider Demographics
NPI:1932324001
Name:ELLIS, RANATA CHARICE
Entity Type:Individual
Prefix:MRS
First Name:RANATA
Middle Name:CHARICE
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 1:4201 VICTORY PKWY
Mailing Address - Street 2:APT. 409
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1645
Mailing Address - Country:US
Mailing Address - Phone:513-544-2273
Mailing Address - Fax:
Practice Address - Street 1:4201 VICTORY PKWY
Practice Address - Street 2:APT. 409
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1645
Practice Address - Country:US
Practice Address - Phone:513-544-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-112182164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2562187Medicaid