Provider Demographics
NPI:1013780758
Name:ELLIS, ANNE CALLIS (BSN RN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CALLIS
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-1421
Mailing Address - Country:US
Mailing Address - Phone:618-294-6591
Mailing Address - Fax:
Practice Address - Street 1:227 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-1421
Practice Address - Country:US
Practice Address - Phone:618-552-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041477985163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator