Provider Demographics
NPI:1699948331
Name:MAMOLEN, ELLEN MARLENE (FNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARLENE
Last Name:MAMOLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-9731
Mailing Address - Country:US
Mailing Address - Phone:775-463-3335
Mailing Address - Fax:775-463-2709
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9731
Practice Address - Country:US
Practice Address - Phone:775-463-3335
Practice Address - Fax:775-463-2709
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN1018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily