Most Relevant Information
Provider Data
| NPI Number: | 1003325424 |
| Provider Name: | TARA LYNN ELLIS RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WS0200X |
| Specialty: | Registered Nurse |
| License Number: | 591941 |
Most Important Dates
| Enumeration Date: | 09/28/2017 |
| Last Updated: | 09/28/2017 |
Provider Practice Location
23 HUSKY LANE
MALONE
NY
12953
Practice Location Phone/Fax
| Phone: | 5184835230 |
| Fax: |
Provider Mailing Location
530 PORTER RD
MALONE
NY
129533804
Provider Mailing Phone/Fax
| Phone: | 15184835230 |
| Fax: |