Individual
HOWARD N ELLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Mailing address
2720 SUNSET BLVD, ATT CREDENTIALING, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
66315
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
R00066315
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GAN200
—
SC
Enumeration date
07/25/2006
Last updated
10/15/2007
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