Individual
DR. WAYNE ENOCH ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., CRNA
Contact information
Practice address
1038 N EISENHOWER DR, SUITE 152, BECKLEY, WV 25801-3116
(304) 731-0102
(270) 342-0001
Mailing address
1038 N EISENHOWER DR, SUITE 152, BECKLEY, WV 25801-3116
(304) 731-0102
(270) 342-0001
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
65453
WV
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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