Provider Demographics
NPI:1356346233
Name:KLATT-ELLIS, TONI (CNS)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:KLATT-ELLIS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660376
Mailing Address - Street 2:ELKHART GENERAL HOSPITAL INSURANCE PAYMENTS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0376
Mailing Address - Country:US
Mailing Address - Phone:574-523-3148
Mailing Address - Fax:574-523-3492
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3112
Practice Address - Fax:574-523-7885
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000010A364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200258130AMedicaid
IN000000725198OtherANTHEM
P50184Medicare UPIN
IN000000725198OtherANTHEM
IN216950NMedicare PIN