Provider Demographics
NPI:1720317985
Name:ELLINGTON, KATHERINE D
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:ELLINGTON
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 1:11006 195TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2010
Mailing Address - Country:US
Mailing Address - Phone:347-993-7877
Mailing Address - Fax:347-214-9175
Practice Address - Street 1:11006 195TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2010
Practice Address - Country:US
Practice Address - Phone:347-993-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program