MEDICARE: DIANE ELMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	72600	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72600	OTHER	NM	STATELICENSE

General Provider Information

NPI Number	:	1144926767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ELMAN

Provider Business Mailing Address
First Line	:	1811 LEAD AVE SE APT 16
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4076
Country	:	US
Telephone Number	:	877-416-6474
Fax Number	:	505-355-2684

Provider Business Practice Location Address
First Line	:	1811 LEAD AVE SE APT 16
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4076
Country	:	US
Telephone Number	:	877-416-6474
Fax Number	:	505-355-2684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	03/02/2026

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Directions to “ DIANE ELMAN ” Practice Location

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