Individual
KEITH G ELLSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
155 MEMORIAL DR, PINEHURST, NC 28374-8710
(910) 715-1233
(910) 715-1943
Mailing address
PO BOX 8500, PINEHURST, NC 28374-8500
(910) 715-5413
(910) 715-1926
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
119861
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050425
—
NC
Enumeration date
06/10/2006
Last updated
07/08/2007
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