Provider Demographics
NPI:1285032482
Name:ELLIS, ANNA (APRN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W MOANA LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4903
Mailing Address - Country:US
Mailing Address - Phone:775-324-0699
Mailing Address - Fax:775-323-6814
Practice Address - Street 1:6536 S MCCARRAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6152
Practice Address - Country:US
Practice Address - Phone:775-982-8255
Practice Address - Fax:775-982-8251
Is Sole Proprietor?:No
Enumeration Date:2014-12-21
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12784979OtherCAQH #
NVAPRN001795OtherSTATE LICENSE