Individual
SAMUEL HAYWARD ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(509) 432-4529
(208) 765-8486
Mailing address
1028 COMPTON CT, MOSCOW, ID 83843-8531
(509) 432-4529
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
43-557976-071
KS
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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