| Doctor Name: | MRS. LAURIE ELLIS |
| NPI Number: | 1962508754 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C. |
| License Number: | C0000980 |
| Business Practice Address: | 19 W Frederick St Walkersville, MD - 217938230 |
| Business Phone Number: | 3018456336 |
| Business Fax Number: | 2405784478 |
| Mailing Address: | 610 Solarex Ct, FREDERICK |
| State: | MD |
| Postal Code: | 217038624 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 02/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0000980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |