Provider Demographics
NPI:1295418440
Name:NELLIS, ERIN JOY
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JOY
Last Name:NELLIS
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 1:5298 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6003
Mailing Address - Country:US
Mailing Address - Phone:216-849-8195
Mailing Address - Fax:
Practice Address - Street 1:5298 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6003
Practice Address - Country:US
Practice Address - Phone:216-849-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide