Provider Demographics
NPI:1972626406
Name:ELLIS, TAMI J (DT)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2035
Mailing Address - Country:US
Mailing Address - Phone:317-840-8049
Mailing Address - Fax:317-773-8569
Practice Address - Street 1:1454 MONUMENT ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2035
Practice Address - Country:US
Practice Address - Phone:317-840-8049
Practice Address - Fax:317-773-8569
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist