Provider Demographics
NPI:1336841329
Name:HART, ELLEN E
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:HART
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 1:637 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2620
Mailing Address - Country:US
Mailing Address - Phone:330-389-3097
Mailing Address - Fax:
Practice Address - Street 1:637 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2620
Practice Address - Country:US
Practice Address - Phone:330-389-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant