Active NPI
Ellen Fortun
- Licensed Practical Nurse
- Plymouth Meeting, PA
National Provider Identifier
1902082829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN 5156444
- Practice address
- 2250 Hickory Rd
Suite 240
Plymouth Meeting, PA 19462-1047 - Phone
- (610) 834-1122
- NPI assigned
- Jan 10, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 5156444 | FL | Primary |
Addresses
Primary practice location
2250 Hickory Rd
Suite 240
Plymouth Meeting, PA 19462-1047
Mailing address
2871 SE Italy St
Port St Lucie, FL 34952-5587
Phone (772) 940-2403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN 5156444 | FL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199923200000",
"number": "1902082829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2871 SE ITALY ST",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525587",
"telephone_number": "772-940-2403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 HICKORY RD",
"address_2": "SUITE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194621047",
"telephone_number": "610-834-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUN",
"first_name": "ELLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-10",
"last_updated": "2008-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "FL",
"license": "PN 5156444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth Meeting, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.