Individual
MISS SHARETTA ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GRADUATE NURSE
Contact information
Practice address
2525 E LAKE SHORE DR APT 608, WACO, TX 76705-7804
(254) 732-2712
Mailing address
2525 E LAKE SHORE DR APT 608, WACO, TX 76705-7804
(254) 732-2712
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
21075973
TX
Other
Enumeration date
04/25/2008
Last updated
04/25/2008
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