Provider Demographics
NPI:1063082287
Name:PLITT, ELLEN (MSN, CRNA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:PLITT
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:DEKLEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1800
Practice Address - Country:US
Practice Address - Phone:502-629-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015857163W00000X
KY3017235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse