Individual
ROBERT L ELLISON
Active
Individual
ROBERT L ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
N13917
ID
367500000X
Certified Registered Nurse Anesthetist
AP30004667
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-209
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805788500
—
ID
05
—
9628264
—
WA
01
—
A3565
BC ID
ID
01
—
N13917
IDAHO LICENSE
ID
01
—
P00137189
RAILROAD MEDICARE
—
Enumeration date
08/30/2005
Last updated
07/13/2010
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