Healthcare Provider Details

I. General information

NPI: 1073397477
Provider Name (Legal Business Name): ELSA LIM LINATOC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 217
LAS VEGAS NV
89119-5251
US

IV. Provider business mailing address

7764 ALOLA SPRINGS LN
NORTH LAS VEGAS NV
89084-3819
US

V. Phone/Fax

Practice location:
  • Phone: 702-787-4144
  • Fax:
Mailing address:
  • Phone: 702-787-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number821972
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: