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General NPI Number Information
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NPI Number | 1932272127
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Entity Type | Individual
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Provider Name | ELIZABETH KENETTE ELLIN NBC-HIS
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 720 N MERIDIAN
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City | BLACKFOOT
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State | ID
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Zip | 83221
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Country | US
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Telephone | 208-785-5551
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Fax | 208-782-9580
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Provider Business Mailing Address
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Address Line | 4155 YELLOWSTONE AVE
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City | POCATELLO
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State | ID
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Zip | 83202-2345
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Country | US
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Telephone | 208-238-0020
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Fax | 208-238-0021
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA-182
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License Number State | ID
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