Healthcare Provider Details

I. General information

NPI: 1922012186
Provider Name (Legal Business Name): ELAINE MARIE NEARY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY VA MEDICAL CENTER
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

4184 KNOLLCREST CIR N
MARTINEZ GA
30907-1672
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN121837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: