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Individual

KURT MERVIN ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN.

Contact information

Practice address
1639 FORUM PL STE 7, WEST PALM BEACH, FL 33401-2330
(561) 712-8821
Mailing address
7295 SE CRAIG ST, HOBE SOUND, FL 33455-6114
(570) 506-3157

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5222714
FL

Other

Enumeration date
01/28/2020
Last updated
01/28/2020
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