Provider Demographics
NPI:1699294397
Name:ELLIS, LINDA ELAINE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ELAINE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N BELTLINE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7402
Mailing Address - Country:US
Mailing Address - Phone:843-758-6550
Mailing Address - Fax:843-664-8475
Practice Address - Street 1:221 N BELTLINE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7402
Practice Address - Country:US
Practice Address - Phone:843-758-6550
Practice Address - Fax:843-664-8475
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC61349-163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool