Healthcare Provider Details

I. General information

NPI: 1639373970
Provider Name (Legal Business Name): JON M ELKIN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 RENAISSANCE PKWY
DURHAM NC
27713-6688
US

IV. Provider business mailing address

1106 PROFESSOR PL
DURHAM NC
27713-6099
US

V. Phone/Fax

Practice location:
  • Phone: 800-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 919-618-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201497
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: