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General NPI Number Information
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NPI Number | 1841521481
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Entity Type | Individual
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Provider Name | DAVID S ELLISON CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 4305 NEW SHEPHERDSVILLE RD ANESTHESIA DEPARTMENT
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City | BARDSTOWN
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State | KY
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Zip | 40004-9019
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Country | US
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Telephone | 502-350-5032
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Fax | 502-350-5022
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Provider Business Mailing Address
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Address Line | 6801 DIXIE HWY SUITE 130
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City | LOUISVILLE
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State | KY
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Zip | 40258-3913
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Country | US
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Telephone | 502-315-1458
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Fax | 502-479-1425
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 14616
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3007236
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License Number State | KY
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