Provider Demographics
NPI:1982877908
Name:ELLIS, CAROLYN JEAN (HEALTH SERVICES TECH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:HEALTH SERVICES TECH
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Mailing Address - Street 1:2901 TURTLE CREEK DR
Mailing Address - Street 2:ATTN: HS CAROLYN ELLIS
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8056
Mailing Address - Country:US
Mailing Address - Phone:409-723-6545
Mailing Address - Fax:
Practice Address - Street 1:2901 TURTLE CREEK DR
Practice Address - Street 2:ATTN: HS CAROLYN ELLIS
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8056
Practice Address - Country:US
Practice Address - Phone:409-723-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other