Healthcare Provider Details

I. General information

NPI: 1811130883
Provider Name (Legal Business Name): ELISE STORZ GARRETT CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NEILSON ST
WATSONVILLE CA
95076-2468
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-8250
  • Fax: 831-728-8266
Mailing address:
  • Phone: 831-728-0222
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number13783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: