Individual
TRAVIS O ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5503
Mailing address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5503
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
64717
WV
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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