Healthcare Provider Details

I. General information

NPI: 1962532234
Provider Name (Legal Business Name): JENNIFER LEE ELROD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

1903 BUENA TIERRA ST
BENICIA CA
94510-2304
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2012
  • Fax:
Mailing address:
  • Phone: 707-297-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number577905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number577905
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number577905
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number577905
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number577905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: