| Organization Name: | DAN ELLIS GNP INC |
| NPI Number: | 1942552732 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN ELLIS (PRESIDENT) |
| Mailing Address: | 703b Farmer St Port Gibson |
| State: | MS US |
| Postal Code: | 391502319 |
| Phone Number: | 6015292871 |
| Fax Number: | 6016299969 |
| NPI Enumeration Date: | 10/04/2012 |
| NPI Last Update Date: | 12/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R826981 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |