Ellis, Genie Marie

Ellis, Genie Marie is an individual health care provider with primary practice located at 3200 Canyon Lake Dr , Rapid City SD 57702-8114. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Ellis, Genie Marie can be contacted via phone (605) 355-2443.

Contact Information

Primary practice address
3200 Canyon Lake Dr Rapid City SD 57702-8114
Fax: (650) 355-2403
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0229CNP South Dakota

Profile Details

NPI number 1649233677
LBN Legal business name Ellis, Genie Marie
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2006
Last updated Nov 8th, 2011 - about 13 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 1649233677 NPPES
South Dakota MEDICAID 5549050

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