| Doctor Name: | MRS. VICTORIA NICOLE ELLIS |
| NPI Number: | 1467609149 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 01166 |
| Business Practice Address: | 200 Vance St Chapmanville, WV - 255089422 |
| Business Phone Number: | 3048550425 |
| Business Fax Number: | 3048550427 |
| Mailing Address: | 7400 Lynn Ave, HAMLIN |
| State: | WV |
| Postal Code: | 255231138 |
| Phone Number: | 3048245806 |
| Fax Number: | 3048245804 |
| NPI Enumeration Date: | 08/25/2008 |
| NPI Last Update Date: | 02/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 01166 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |