Basic Information
| Provider Information | |||||||||
| NPI: | 1396835518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ULLER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNM, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 E DIVISADERO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594432682 | ||||||||
| FaxNumber: | 5594432681 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 N WAYTE LN | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937012124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594595755 | ||||||||
| FaxNumber: | 5594594453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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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 | 176B00000X | 327 | NC | N | Other Service Providers | Midwife | 363LX0001X | NP9321 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | 1265 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | NP9321 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | RN500942 | CA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 327 | 01 | NC | NURSE MIDWIFERY | OTHER |