Provider Demographics
NPI:1972154078
Name:ELLEMAN, DEANNA (FNP-BC, MSN, BSN, RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:ELLEMAN
Suffix:
Gender:F
Credentials:FNP-BC, MSN, BSN, RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:ELLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:240 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4131
Mailing Address - Country:US
Mailing Address - Phone:765-238-8920
Mailing Address - Fax:
Practice Address - Street 1:FIRST CARE CLINIC
Practice Address - Street 2:3600 E MAIN ST.
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4131
Practice Address - Country:US
Practice Address - Phone:765-598-5700
Practice Address - Fax:765-598-5741
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009384A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily