Healthcare Provider Details

I. General information

NPI: 1649258591
Provider Name (Legal Business Name): ELINOR L BETHKE R.M.N.S C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 DIAMOND DR
ALAMOSA CO
81101-2016
US

IV. Provider business mailing address

711 DIAMOND DR
ALAMOSA CO
81101-2016
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-5800
  • Fax: 719-589-5800
Mailing address:
  • Phone: 719-589-5800
  • Fax: 719-589-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number37167
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: