Healthcare Provider Details

I. General information

NPI: 1467544999
Provider Name (Legal Business Name): ELISE MARIE PALITZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE #405
MODESTO CA
95350-4500
US

IV. Provider business mailing address

PO BOX 1319
SALIDA CA
95368-1319
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5885
  • Fax:
Mailing address:
  • Phone: 209-543-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN284151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: