Individual
PHILIP RESIN ELACKATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(986) 256-1766
Mailing address
3307 IVY MILL LN, MISSOURI CITY, TX 77459-6525
(630) 765-4384
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
Primary
900887
TX
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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