Keith Lawrence Ellis
Nurse Practitioner, Pediatrics in Bridgeport, CT. Individual provider (NPI-1).
NPI number1144654666
StatusActive
Last updated in NPPESSep 12, 2022
Details
- NPI
- 1144654666
- Entity type
- Individual (NPI-1)
- Name
- Keith Lawrence Ellis
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 3, 2013
- Certification date
- Sep 12, 2022
- Last updated
- Sep 12, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 5501 | CT | Yes |
Practice location
46 Albion StBridgeport, CT 06605-2602
Phone 203-330-6000 · Fax 203-330-6008
Mailing address
46 Albion StBridgeport, CT 06605-2602
Phone 203-330-6000 · Fax 203-330-6008
Other practice locations
282 Washington St
Hartford, CT 06106-3322
Hartford, CT 06106-3322
Phone 860-837-7250 · Fax 860-837-6970
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