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Individual

JEANETTE ILENE ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NURSE ANESTHETIST

Contact information

Practice address
2 GOOD SAMARITAN WAY STE 205, MOUNT VERNON, IL 62864-2476
(618) 899-3869
(618) 899-3558
Mailing address
809 APACHE DR, SIKESTON, MO 63801-4015
(573) 703-3298

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
118890
IL

Other

Enumeration date
10/25/2018
Last updated
10/25/2018
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