Jarrod Thomas Ellis
Student in an Organized Health Care Education/Training Program in Syracuse, NY. Individual provider (NPI-1).
NPI number1003497652
StatusActive
Last updated in NPPESApr 15, 2021
Details
- NPI
- 1003497652
- Entity type
- Individual (NPI-1)
- Name
- Jarrod Thomas Ellis
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 15, 2021
- Certification date
- Apr 15, 2021
- Last updated
- Apr 15, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
750 E Adams StSyracuse, NY 13210-2306
Phone 315-464-6635
Mailing address
136 Lakeview DrMc Kees Rocks, PA 15136-1233
Phone 412-926-4634
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