Healthcare Provider Details

I. General information

NPI: 1497643423
Provider Name (Legal Business Name): ELIZABETH NJOME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CAMPUS DR
MISSOULA MT
59812-0003
US

IV. Provider business mailing address

253 CINNABAR WAY
HERCULES CA
94547-1718
US

V. Phone/Fax

Practice location:
  • Phone: 510-859-5933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: