Provider Demographics
NPI:1700506946
Name:SYDNOR, ELLEN MARIE
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:SYDNOR
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 1:13923 N 102ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-9209
Mailing Address - Country:US
Mailing Address - Phone:480-860-2208
Mailing Address - Fax:
Practice Address - Street 1:8850 E PIMA CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4619
Practice Address - Country:US
Practice Address - Phone:480-800-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN070031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse