Ellison, Robert L

Ellison, Robert L is an individual health care provider with primary practice located at 2300 W A St , Moscow ID 83843-4038. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Ellison, Robert L can be contacted via phone (208) 883-1500.

Contact Information

Primary practice address
2300 W A St Moscow ID 83843-4038
Phone: (208) 883-1500
Fax: (208) 882-7701
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X N13917 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RNA-209 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X AP30004667 Washington

Profile Details

NPI number 1265425714
LBN Legal business name Ellison, Robert L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2005
Last updated Jul 13th, 2010 - about 15 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 1265425714 NPPES
Washington MEDICAID 9628264
Washington Other A3565
Washington Other N13917
Washington Other P00137189
Washington MEDICAID 805788500

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