Individual
MARY BETH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1325 S CLIFF AVE, SIOUX FALLS, SD 57105-1007
(605) 322-2754
Mailing address
PO BOX 5045, ATTN: P.F.S. PROV ENROLL, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CR000759
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306136098
DAKOTACARE
—
Enumeration date
04/14/2011
Last updated
09/01/2011
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