Individual
MARK ALAN ELLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 604-1715
Mailing address
3817 NORA ST, POCATELLO, ID 83204-2023
(208) 604-1715
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
45067
ID
363LA2100X
Acute Care Nurse Practitioner
Primary
69540
ID
Other
Enumeration date
08/27/2021
Last updated
08/30/2021
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