Individual
MILES ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SRNA
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Mailing address
16227 RAVINA WAY, NAPLES, FL 34110-3269
(231) 633-1829
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
4704295031
MI
390200000X
Student in an Organized Health Care Education/Training Program
RN9418207
FL
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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