Healthcare Provider Details

I. General information

NPI: 1437286143
Provider Name (Legal Business Name): JONI LYNN ELLIOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG USAG BAMBERG
APO AE
09244
DE

IV. Provider business mailing address

USAMEDDAC WUERZBERG ATTN CREDENTIALS OFFICE UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 01149513001741
  • Fax:
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number11885
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: