Provider Demographics
NPI:1609654961
Name:ELLIS, ESTHER NICOLE (BSN, RN, NBSN)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:NICOLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BSN, RN, NBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-0795
Mailing Address - Country:US
Mailing Address - Phone:808-384-7014
Mailing Address - Fax:
Practice Address - Street 1:5200 HHR RANCH RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9210
Practice Address - Country:US
Practice Address - Phone:307-733-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY29751163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool