Ellis, Thomas Kevin

Ellis, Thomas Kevin is an individual health care provider with primary practice located at 640 Jackson St Mail Stop 11503P, Saint Paul MN 55101-2502. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Ellis, Thomas Kevin can be contacted via phone (651) 254-3456.

Contact Information

Primary practice address
640 Jackson St Mail Stop 11503P Saint Paul MN 55101-2502
Phone: (651) 254-3456
Fax: (651) 254-3048
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R0628291 Minnesota

Profile Details

NPI number 1356317580
LBN Legal business name Ellis, Thomas Kevin
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2006
Last updated Dec 31st, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356317580 NPPES
Minnesota MEDICAID 437842300

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