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Lori Lea Ellis

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NPI Number Detailed Information

Provider Information:

Name: Lori Lea Ellis
Gender: F
Provider License Number If Given: AO1691

NPI Information:

NPI: 1396748380
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 10/4/2007

Provider Business Mailing Address:

Address: 606 W ARCH AVE STE A
Searcy, AR 72143
Phone Number: 5012790211
Fax Number: 5012790213

Provider Business Practice Location Address:

Address: 606 W ARCH AVE STE A
Searcy, AR 72143
Phone Number: 5012790211
Fax Number: 5012790213

Provider Taxonomy:

Primary: 363LF0000X
Secondary (if any):
State: AR

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