Provider Demographics
NPI:1053759654
Name:MACRI, ELLEN MARIE
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:MACRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SOUTH FUQUAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY-VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-753-5909
Mailing Address - Fax:
Practice Address - Street 1:119 SOUTH FUQUAY AVENUE
Practice Address - Street 2:
Practice Address - City:FUQUAY-VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-753-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist