Healthcare Provider Details

I. General information

NPI: 1053619346
Provider Name (Legal Business Name): NAOMI E ELCOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 MOUNT OAK RD
BOWIE MD
20716-1246
US

IV. Provider business mailing address

15400 MOUNT OAK RD
BOWIE MD
20716-1246
US

V. Phone/Fax

Practice location:
  • Phone: 310-613-0110
  • Fax: 301-390-2549
Mailing address:
  • Phone: 301-613-0110
  • Fax: 410-523-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR075339
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR075339
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR075339
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberR075339
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR075339
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberR075339
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberR075339
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR075339
License Number StateMD
# 9
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR075339
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: