Ellis, Jolene
Ellis, Jolene is an individual health care provider with primary practice located at 760 W Franklin St , Jackson MI 49201-2048. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Ellis, Jolene can be contacted via phone (517) 780-9260.Contact Information
Primary practice address
760 W Franklin St
Jackson MI 49201-2048
Phone: (517) 780-9260
Fax: (517) 780-9263
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 4301058029 | Michigan |
Profile Details
| NPI number | 1255395612 |
|---|---|
| LBN Legal business name | Ellis, Jolene |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 13th, 2006 |
| Last updated | Mar 3rd, 2020 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255395612 | NPPES |
| Michigan | MEDICAID | 4649460 |
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