Provider Demographics
NPI:1558993378
Name:ELLARD, ANGELA (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:ELLARD
Suffix:
Gender:
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 ERIE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1741
Mailing Address - Country:US
Mailing Address - Phone:513-255-5555
Mailing Address - Fax:
Practice Address - Street 1:3406 ERIE AVE STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1741
Practice Address - Country:US
Practice Address - Phone:513-255-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.396624251J00000X
OHAPRN.CNP.021512363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251J00000XAgenciesNursing Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid