Provider Demographics
NPI:1043922263
Name:ELLIS, DESTINEE CHARMAYNE (CPE)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:CHARMAYNE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 MAZETTE PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1818
Mailing Address - Country:US
Mailing Address - Phone:412-378-3184
Mailing Address - Fax:
Practice Address - Street 1:2109 MAZETTE PL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1818
Practice Address - Country:US
Practice Address - Phone:412-378-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula