Provider Demographics
NPI:1417996521
Name:ELLINGTON, JAMES OSBORNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:OSBORNE
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SORIANO ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-6691
Mailing Address - Country:US
Mailing Address - Phone:940-262-3058
Mailing Address - Fax:
Practice Address - Street 1:10000 SORIANO ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-6691
Practice Address - Country:US
Practice Address - Phone:940-262-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54140367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered