Provider Demographics
NPI:1962248286
Name:FLORA ELLEN HEALTH, LLC
Entity type:Organization
Organization Name:FLORA ELLEN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESTICE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:802-505-9030
Mailing Address - Street 1:159 STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3301
Mailing Address - Country:US
Mailing Address - Phone:802-505-9030
Mailing Address - Fax:
Practice Address - Street 1:159 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3301
Practice Address - Country:US
Practice Address - Phone:802-505-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty