Individual
MATTHEW FORREST ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 ANGUS E PEYTON DR, SOUTH CHARLESTON, WV 25303-1600
(304) 746-2500
Mailing address
136 BAYSIDE DR, HUNTINGTON, WV 25705-2533
(304) 228-7323
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
113031
WV
Other
Enumeration date
04/02/2022
Last updated
02/20/2024
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