Provider Demographics
NPI:1871052068
Name:TREADWAY, ELLEN E (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:E
Last Name:TREADWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:ESCARENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8425 MANION DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3926
Mailing Address - Country:US
Mailing Address - Phone:281-386-6730
Mailing Address - Fax:
Practice Address - Street 1:2194 EASTEX FWY STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-4981
Practice Address - Country:US
Practice Address - Phone:409-899-2750
Practice Address - Fax:409-899-2757
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139519363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner