Provider Demographics
NPI:1982104048
Name:ELLSWORTH, DEBRA A (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MT PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1987
Mailing Address - Country:US
Mailing Address - Phone:570-342-8500
Mailing Address - Fax:
Practice Address - Street 1:531 MT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1987
Practice Address - Country:US
Practice Address - Phone:570-342-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN272836L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse