Lisa Marie Ellis

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

305539 Issued in NY

Practice address

1050 W Genesee St
Syracuse, NY 13204-2215

Phone

(315) 424-3744

Fax

(315) 424-3715

NPI assigned

Feb 17, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Marie Edwards Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1144593419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042215",
            "telephone_number": "315-424-3744",
            "fax_number": "315-424-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042215",
            "telephone_number": "315-424-3744",
            "fax_number": "315-424-3715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-17",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "305539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "EDWARDS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sabah Elliott
• W. Clayton Elliott, MD
• Brennan Ellis, M.D.
• Charli Ellis, DO
• Jarrod Thomas Ellis
• Markia Ellis
• Sarah A Ellithorpe, PT
• Brian Ellsworth
• Ruba Elmaoued, MD
• Elmcrest Childrens Center

• Licensed Practical Nurse in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.