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General NPI Number Information
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NPI Number | 1063547271
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Entity Type | Individual
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Provider Name | JANET RAYE ELLIS CST, LFA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4601 50TH ST SUITE 106
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City | LUBBOCK
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State | TX
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Zip | 79414-3513
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Country | US
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Telephone | 806-785-2093
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Fax |
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Provider Business Mailing Address
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Address Line | 311 E 19TH ST
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City | WOLFFORTH
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State | TX
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Zip | 79382-2809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | SA00066
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License Number State | TX
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