Healthcare Provider Details

I. General information

NPI: 1518676675
Provider Name (Legal Business Name): BRENDA LEE ELKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38883 CALIFORNIA HWY 299
WILLOW CREEK CA
95573
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3111
  • Fax: 530-629-3122
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95307131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: