MARK ALAN ELLETT

IDAHO FALLS, ID
NPI1295402089
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LA2100X Nurse Practitioner, Acute Care
(Licence: ID  69540)
Additional Taxonomies163WC0200X Registered Nurse, Critical Care Medicine
(Licence: ID  45067)
Enumeration Date2021-08-27
Last Update Date2021-08-30
Business Address
MARK ALAN ELLETT AGACNP
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-604-1715
Mailing Address
MARK ALAN ELLETT AGACNP
3817 NORA ST
POCATELLO, ID 83204-2023
Phone number: 208-604-1715