Most Relevant Information
Provider Data
| NPI Number: | 1003699158 |
| Provider Name: | ELLEN FLORA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/14/2023 |
| Last Updated: | 08/15/2023 |
Provider Practice Location
101 W UNIVERSITY AVE
CHAMPAIGN
IL
618203981
Practice Location Phone/Fax
| Phone: | 2173661248 |
| Fax: |
Provider Mailing Location
4550 NICKLAUS DR APT 306
CHAMPAIGN
IL
618221508
Provider Mailing Phone/Fax
| Phone: | 8036452068 |
| Fax: |