Individual
MELONY D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
701 N 1ST ST, ANESTHESIA DEPARTMENT, SPRINGFIELD, IL 62781-0002
(217) 788-7354
(217) 788-7021
Mailing address
701 N 1ST ST, ANESTHESIA DEPARTMENT, SPRINGFIELD, IL 62781-0001
(217) 788-7354
(217) 788-7021
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079201
CCNA CERTIFICATION
IL
Enumeration date
02/18/2008
Last updated
02/18/2008
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