Healthcare Provider Details

I. General information

NPI: 1043977721
Provider Name (Legal Business Name): JOSEPH LEE ELIASON CNP, FNP-C, CWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NM - 564
GALLUP NM
87301-5881
US

IV. Provider business mailing address

2418 E HISTORIC HIGHWAY 66 # 292
GALLUP NM
87301-4767
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-3681
  • Fax: 505-473-9552
Mailing address:
  • Phone: 505-906-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-CNP69689
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: