Individual
ETHAN A ELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4150 V STREET, PSSB SUITE 1200, UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE, SACRAMENTO, CA 95817-1460
(916) 734-5042
(916) 734-2975
Mailing address
4150 V STREET, PSSB SUITE 1200, UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE, SACRAMENTO, CA 95817-1460
(916) 734-5042
(916) 734-2975
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
586167
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
586167
RN LICENSE
CA
Enumeration date
01/20/2009
Last updated
01/20/2009
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