Provider Demographics
NPI:1215452024
Name:WERMTER, ELLEN ESTHER (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ESTHER
Last Name:WERMTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIVERBEND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8695
Mailing Address - Country:US
Mailing Address - Phone:434-202-4199
Mailing Address - Fax:
Practice Address - Street 1:125 RIVERBEND DR STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8695
Practice Address - Country:US
Practice Address - Phone:434-202-4199
Practice Address - Fax:844-927-4496
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010067529Medicaid