Individual
MR. JOHN KENNY ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12516 CRESTLINE AVE NE, ALBUQUERQUE, NM 87112-3616
(505) 323-9170
Mailing address
12516 CRESTLINE AVE NE, ALBUQUERQUE, NM 87112-3616
(505) 323-9170
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
R21266
NM
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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