Provider Demographics
NPI:1063916104
Name:ELLIS, ERIN BRETT (NMD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:BRETT
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4263
Mailing Address - Country:US
Mailing Address - Phone:480-630-1665
Mailing Address - Fax:833-606-5543
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4263
Practice Address - Country:US
Practice Address - Phone:480-630-1665
Practice Address - Fax:833-606-5543
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1698175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath