MRS. Stephanie M Ellis, PA

NPI #1922313238 in Peoria, Illinois

Provider Information

NPI Number: 1922313238
Entity Type: Individual
Name: MRS. Stephanie M Ellis, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Aug 11, 2010
Last Updated: Aug 11, 2010

Practice Location

Address: 4909 N GLEN PARK PLACE RD
City: Peoria
State: Illinois
ZIP Code: 61614-4676
Phone: (309) 674-7546

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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