LISA A. ELLINGWOOD (NPI# 1083255343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083255343 |
| Entity Type | Individual |
| Full Name | LISA A. ELLINGWOOD |
| Other Name | LISA ANNETTE ELLINGWOOD |
| Credential | RN |
| Practice Address |
1802 S Mattis Ave Champaign IL 61821-5923 |
| Mailing Address |
2305 Grange Dr Urbana IL 61801-6665 |
| Practice Telephone | 2178987064 |
| Practice Fax Number | 2172559723 |
| Mailing Telephone | 2178987064 |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2020-06-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 041.385774 | IL | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
209.020407 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1802 S MATTIS AVE |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61821-5923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568459030 | Bart Wayne Gastwirth | Podiatrist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2005-09-30 |
| 1982230124 | Bradley Thompson | Registered Nurse | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-03-19 |
| 1710510136 | Jeanie Mickelsen | Social Worker | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-02-13 |
| 1003456369 | Rachael D Rubin | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-01-14 |
| 1114563640 | Mary K Kiesewetter | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-11-19 |
| 1841843539 | Rakisha Wilks | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-07-22 |
| 1558869081 | Kristin E Thies | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2018-01-30 |
| 1215463971 | Mercy E Eigbike | Psychiatry & Neurology | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2017-05-02 |
| 1770034878 | Tammie Roedl | Social Worker | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2016-10-24 |
| 1881080372 | Deanna Kane | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2015-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326532888 | Cunningham Children's Home of Urbana Il | Residential Treatment Facility, Emotionally Disturbed Children | 1303 N. Cunningham Avenue, Urbana, IL 61821 | 2018-06-19 |
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1457698169 | Mohamad Ata | Registered Nurse | 1802 S. Mattis, Champaign, IL 61821 | 2013-01-15 |
| 1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
| 1679850887 | Kirk Donald Gohsman | Counselor | 106 S. Country Fair Drive, Suite C, Champaign, IL 61821 | 2011-11-16 |
| 1598054777 | Delbert William Nelson Jr. | Psychiatry & Neurology | 2115 Galen Dr, Champaign, IL 61821 | 2011-03-28 |
| 1790946929 | Rdi Vein LLC | Clinic/Center | 2502 Galen Drive, Suite 101, Champaign, IL 61821 | 2008-06-20 |
| 1366620064 | Advanced Aesthetics Surgery & Laser Center, P.C. | Clinic/Center | 2111 West Park Ct., Champaign, IL 61821 | 2008-02-05 |
| 1033398482 | Huey's Home Medical, Inc | Durable Medical Equipment & Medical Supplies | 1207 S Mattis Ave Ste 1, Champaign, IL 61821 | 2007-11-01 |
| 1265630537 | Elizabeth Catherine Tingley | Psychologist | Department of Psychiatry and Psychology-carle Physician, 1802 S. Mattis, Champaign, IL 61821 | 2007-07-06 |
| Find all providers in zip 61821 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841843539 | Rakisha Wilks | Nurse Practitioner | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2019-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384451 | Ghea Tiping Degillo | Nurse Practitioner | 4711 Golf Rd Ste 500, Skokie, IL 60076-1208 | 2020-10-22 |
| 1750989620 | Rodney J Pena Jr. | Nurse Practitioner | 1362 Trotters Ln, Bourbonnais, IL 60914-4519 | 2020-10-13 |
| 1609482231 | Crystal Lynn Jordan | Nurse Practitioner | 638 Oakbrook Ave, Chatham, IL 62629 | 2020-09-18 |
| 1497369672 | Mojisola Abayemi Akinfe | Nurse Practitioner | 8572 Stone Creek Blvd, Frankfort, IL 60423-9338 | 2020-09-03 |
| 1508475039 | Hilary Eichie | Nurse Practitioner | 20025 Division St., Crest Hill, IL 60403 | 2020-07-30 |
| 1518585942 | Tabs Behavioral Health Inc | Nurse Practitioner | 13316 Vicarage Dr, Plainfield, IL 60585-5050 | 2020-07-13 |
| 1154946788 | Latisha Trenice Stennis | Nurse Practitioner | 8106 Carol Dr, East Saint Louis, IL 62203-1838 | 2020-06-09 |
| 1114549755 | Maria Andreea Bordeianu | Nurse Practitioner | 6050 N California Ave, Chicago, IL 60659-3916 | 2020-05-16 |
| 1104448968 | Abosede Rachel Babalola | Nurse Practitioner | 2214 Monarch St, Bourbonnais, IL 60914-2780 | 2020-05-14 |
| 1659909406 | Mudira Temilola Oyewole | Nurse Practitioner | 493 Leslie Ct, Des Plaines, IL 60016-8818 | 2020-03-28 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on LISA A. ELLINGWOOD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.