Healthcare Provider Details

I. General information

NPI: 1043264633
Provider Name (Legal Business Name): JEANNE NOTTO ELNADRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 S AVENUE A SUITE A
YUMA AZ
85364-8341
US

IV. Provider business mailing address

2244 S AVENUE A SUITE A
YUMA AZ
85364-8341
US

V. Phone/Fax

Practice location:
  • Phone: 928-276-4477
  • Fax: 928-276-4481
Mailing address:
  • Phone: 928-276-4477
  • Fax: 928-276-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21613
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number21613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: