Provider Demographics
NPI:1043086887
Name:ELLIS, JOYCE GAYLE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:GAYLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5543 BEAGLE CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9103
Mailing Address - Country:US
Mailing Address - Phone:919-819-3096
Mailing Address - Fax:
Practice Address - Street 1:18224 COUNTY ROAD 106
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9688
Practice Address - Country:US
Practice Address - Phone:740-545-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant