Ellis, Kathleen Dunlevy
Ellis, Kathleen Dunlevy is an individual health care provider with primary practice located at 611 E Douglas Rd Ste 208 , Mishawaka IN 46545-1465. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Ellis, Kathleen Dunlevy can be contacted via phone (317) 714-8752.Contact Information
Primary practice address
611 E Douglas Rd Ste 208
Mishawaka IN 46545-1465
Phone: (317) 714-8752
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 10004107A | Indiana |
Profile Details
| NPI number | 1891570545 |
|---|---|
| LBN Legal business name | Ellis, Kathleen Dunlevy |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2023 |
| Last updated | Oct 3rd, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891570545 | NPPES |
| Indiana | MEDICAID | 300080410 |
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