Provider Demographics
NPI:1316491996
Name:HOBAN, ELLEN PALMER (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:PALMER
Last Name:HOBAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:SUE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9008
Mailing Address - Country:US
Mailing Address - Phone:304-933-3885
Mailing Address - Fax:304-933-3887
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9008
Practice Address - Country:US
Practice Address - Phone:304-933-3885
Practice Address - Fax:304-933-3887
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN45835NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health