Ellis, Gayle M.

Ellis, Gayle M. is an individual health care provider with primary practice located at 700 Ray O Vac Dr Suite 220, Madison WI 53711-2479. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Nursing Service Providers / Psychiatric/Mental Health. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Ellis, Gayle M. can be contacted via phone (608) 276-9191.

Contact Information

Primary practice address
700 Ray O Vac Dr Suite 220 Madison WI 53711-2479
Phone: (608) 276-9191
Fax: (608) 276-9144
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2432-057 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 1526-033 Wisconsin
Nursing Service Providers / Psychiatric/Mental Health 163WP0808X Wisconsin

Profile Details

NPI number 1295890259
LBN Legal business name Ellis, Gayle M.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295890259 NPPES
Wisconsin MEDICAID 3914300

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