Provider Demographics
NPI:1952546475
Name:HUNT, ELLEN J (PHN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:HUNT
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:J
Other - Last Name:MISIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1587 STATE HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-4329
Mailing Address - Country:US
Mailing Address - Phone:518-762-3375
Mailing Address - Fax:
Practice Address - Street 1:2714 STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4041
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:518-762-1382
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-287146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse