Daniel Leland Ellsworth
Individual provider Active NPI Driver · Spencer, IA
NPI 1376298232 · NPPES record last updated Feb 18, 2022
Key facts
- NPI
- 1376298232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 514AG2680 (IA)
- Practice address
- 1709 35TH Ave W Unit 1
Spencer, IA 51301-2550 - Phone
- (712) 260-0090
- NPI assigned
- Feb 18, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 514AG2680 | IA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 514AG2680 | IA | Yes |
Addresses
Primary practice location
1709 35TH Ave W Unit 1
Spencer, IA 51301-2550
Mailing address
1607 McNaughton Way
Spencer, IA 51301-2873
Phone (712) 260-0090
Other providers in Spencer, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.