Provider Demographics
NPI:1912138108
Name:FLOWERS, ELLISTINE ROSE (LPN)
Entity type:Individual
Prefix:MS
First Name:ELLISTINE
Middle Name:ROSE
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 OLIVETTE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5205
Mailing Address - Country:US
Mailing Address - Phone:614-390-7045
Mailing Address - Fax:614-501-8355
Practice Address - Street 1:2912 OLIVETTE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5205
Practice Address - Country:US
Practice Address - Phone:614-390-7045
Practice Address - Fax:614-501-8355
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118236164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse