Doctor Name: | MR. DONALD LANCE ELLIS |
NPI Number: | 1649394313 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DONALD ELLIS LMP |
License Number: | MA00014354 |
Business Practice Address: | 2610 B Colby Ave. Everett, WA - 98201 |
Business Phone Number: | 4258701547 |
Business Fax Number: | 4252906936 |
Mailing Address: | 10201 21st Ave W, EVERETT |
State: | WA |
Postal Code: | 982043650 |
Phone Number: | 4253557539 |
Fax Number: | 4252906936 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA00014354 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |