Evans-Ellacott, Traci Eileen

Evans-Ellacott, Traci Eileen is an individual health care provider with primary practice located at 125 E Broad St Suite 305, Elyria OH 44035-6400. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Evans-Ellacott, Traci Eileen can be contacted via phone (440) 414-9100.

Contact Information

Primary practice address
125 E Broad St Suite 305 Elyria OH 44035-6400
Phone: (440) 414-9100
Fax: (440) 322-3454
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X NP-06543 Ohio

Profile Details

NPI number 1588634976
LBN Legal business name Evans-Ellacott, Traci Eileen
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Mar 3rd, 2011 - about 14 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 1588634976 NPPES
Other 500022799 RAILROAD MEDICARE
Other 000000342754 RAILROAD MEDICARE
MEDICAID 2284004 RAILROAD MEDICARE

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