Healthcare Provider Details

I. General information

NPI: 1154265007
Provider Name (Legal Business Name): ELIZABETH TOM ELDHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

2225 WASHITA TRL
EDMOND OK
73003-2238
US

V. Phone/Fax

Practice location:
  • Phone: 559-770-5590
  • Fax:
Mailing address:
  • Phone: 559-770-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: