Provider Demographics
NPI:1013661370
Name:ELLING, AMELIA MADISON
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:MADISON
Last Name:ELLING
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 1:2210 SHERWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1116
Mailing Address - Country:US
Mailing Address - Phone:502-741-0273
Mailing Address - Fax:
Practice Address - Street 1:2210 SHERWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1116
Practice Address - Country:US
Practice Address - Phone:502-741-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program