Individual
DR. KATHLEEN ELOISE ELLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, RN, APRN,BC
Contact information
Practice address
11201 BENTON ST, 111P, LOMA LINDA, CA 92357-1000
(909) 583-6095
(909) 777-3214
Mailing address
22595 CARDINAL ST, GRAND TERRACE, CA 92313-5732
(909) 783-0594
(909) 783-6714
Taxonomy
Speciality
Code
Description
License number
State
364SM0705X
Medical-Surgical Clinical Nurse Specialist
Primary
539
CA
Other
Enumeration date
07/30/2006
Last updated
07/08/2007
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