Ellis, Jacqueline

Ellis, Jacqueline is an individual health care provider with primary practice located at 3333 Evergreen Dr Ne , Grand Rapids MI 49525-9493. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is her primary health care specialty. Ellis, Jacqueline can be contacted via phone (616) 364-4200.

Contact Information

Primary practice address
3333 Evergreen Dr Ne Grand Rapids MI 49525-9493
Phone: (616) 364-4200
Fax: (616) 364-7347
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 4704360147 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 4704360147 Michigan

Profile Details

NPI number 1629596085
LBN Legal business name Ellis, Jacqueline
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2017
Last updated Jan 4th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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