Provider Demographics
NPI:1992145262
Name:COLE, ELLEN (RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHAMISA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3441
Mailing Address - Country:US
Mailing Address - Phone:505-982-2129
Mailing Address - Fax:505-992-1149
Practice Address - Street 1:2001 CHAMISA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3441
Practice Address - Country:US
Practice Address - Phone:505-982-2129
Practice Address - Fax:505-992-1149
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN77016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse