Provider Demographics
NPI:1306734470
Name:ELLIS, PATRICIA LYNN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-4009
Mailing Address - Country:US
Mailing Address - Phone:701-215-8862
Mailing Address - Fax:
Practice Address - Street 1:112 6TH ST S
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254-4009
Practice Address - Country:US
Practice Address - Phone:701-215-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant