Healthcare Provider Details

I. General information

NPI: 1194126680
Provider Name (Legal Business Name): ELIZABETH SPELLMEYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH SOTTERO

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TYDD STEET
EUREKA CA
95501
US

IV. Provider business mailing address

670 9TH STREET SUITE 203
ARCATA CA
95521
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1624
  • Fax: 707-441-1253
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60258208
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number201240461RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: