Basic Information
| Provider Information | |||||||||
| NPI: | 1033308523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLARD | ||||||||
| FirstName: | MARGOT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137919100 | ||||||||
| FaxNumber: | 7137911016 | ||||||||
| Practice Location | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137919100 | ||||||||
| FaxNumber: | 7137911016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 564 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 364SW0102X | 564 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 62876732 | 05 | NM | MEDICAID |