Individual
BRENT ANGEL ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2001 S WOODRUFF AVE STE 9, IDAHO FALLS, ID 83404-6371
(208) 419-3002
(208) 656-5652
Mailing address
2001 S WOODRUFF AVE STE 9, IDAHO FALLS, ID 83404-6371
(208) 419-3002
(208) 656-5652
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-844
ID
Other
Enumeration date
03/02/2010
Last updated
11/02/2022
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