| Doctor Name: | MRS. SANDRA HUDDLESTON ELLIS |
| NPI Number: | 1003028390 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN0000092176 |
| Business Practice Address: | 201 Dooley St Se Cleveland, TN - 373116220 |
| Business Phone Number: | 4237287020 |
| Business Fax Number: | 4234796130 |
| Mailing Address: | 3632 Steeple Chase Ln Ne, CLEVELAND |
| State: | TN |
| Postal Code: | 373235742 |
| Phone Number: | 4234763058 |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | RN0000092176 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |