Provider Demographics
NPI:1952910580
Name:ELLIS, ASHLIE AMBER
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:AMBER
Last Name:ELLIS
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 1:3222 IVY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2108
Mailing Address - Country:US
Mailing Address - Phone:303-377-0370
Mailing Address - Fax:303-393-1291
Practice Address - Street 1:2323 S TROY ST STE 4-180
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1900
Practice Address - Country:US
Practice Address - Phone:303-601-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
CO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20201567070Medicaid