Provider Demographics
NPI:1386701951
Name:ELLIS, DONNA H (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:H
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442
Mailing Address - Street 2:HEIDELBERG MEDDAC
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09102
Mailing Address - Country:US
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:
Practice Address - Street 1:CMR 442
Practice Address - Street 2:HEIDELBERG MEDDAC
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09102
Practice Address - Country:US
Practice Address - Phone:49622-117-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE36597163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant