Provider Demographics
NPI:1730448085
Name:ELLING, JUSTINE D (NP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:D
Last Name:ELLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12504 PRANAV LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1013
Mailing Address - Country:US
Mailing Address - Phone:815-451-6031
Mailing Address - Fax:
Practice Address - Street 1:9 GREENWAY PLZ
Practice Address - Street 2:SUITE 2950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-0905
Practice Address - Country:US
Practice Address - Phone:866-607-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009201363LF0000X
TXAP128167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily