Provider Demographics
NPI:1932215837
Name:ELLIS, ELIZABETH FUSELIER (DNP, APRN, B-C)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FUSELIER
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DNP, APRN, B-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22140 HIGHWAY 90 N
Mailing Address - Street 2:
Mailing Address - City:BEDIAS
Mailing Address - State:TX
Mailing Address - Zip Code:77831-5470
Mailing Address - Country:US
Mailing Address - Phone:936-241-3431
Mailing Address - Fax:
Practice Address - Street 1:22140 HIGHWAY 90 N
Practice Address - Street 2:
Practice Address - City:BEDIAS
Practice Address - State:TX
Practice Address - Zip Code:77831-5470
Practice Address - Country:US
Practice Address - Phone:936-241-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS53469Medicare UPIN
TXS53469Medicare UPIN