Fennell, Elly Jo
Fennell, Elly Jo is an individual health care provider with primary practice located at 720 Eskenazi Ave , Indianapolis IN 46202-5187. She recently has 4 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist, Nursing Service Providers / Registered Nurse. Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist is her primary health care specialty. Fennell, Elly Jo can be contacted via phone (317) 880-7666.Contact Information
Primary practice address
720 Eskenazi Ave
Indianapolis IN 46202-5187
Phone: (317) 880-7666
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 209.008173 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 209.008173 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 370911138 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist | 364S00000X | 71009460A | Indiana |
| Nursing Service Providers / Registered Nurse | 163W00000X | 041-280081 | Illinois |
Profile Details
| NPI number | 1114245958 |
|---|---|
| LBN Legal business name | Fennell, Elly Jo |
| Credentials | RN, CNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2010 |
| Last updated | Nov 18th, 2021 - about 3 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 | 1114245958 | NPPES |
| Illinois | Other | 041-280081 | RN LICENSE |
| Illinois | MEDICAID | 036102163 | RN LICENSE |
| Illinois | Other | 209.008173 | RN LICENSE |
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