Provider Demographics
NPI:1013114024
Name:NAUMANN, ELLISA JEAN (PHN, RN)
Entity Type:Individual
Prefix:MS
First Name:ELLISA
Middle Name:JEAN
Last Name:NAUMANN
Suffix:
Gender:F
Credentials:PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4026
Mailing Address - Country:US
Mailing Address - Phone:209-381-1158
Mailing Address - Fax:209-381-1173
Practice Address - Street 1:260 E. 15TH STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-381-1158
Practice Address - Fax:209-381-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304169163WC1500X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient