Healthcare Provider Details

I. General information

NPI: 1306993266
Provider Name (Legal Business Name): ELSIE B HOWARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KOTNUM ROAD
WARM SPRINGS OR
97761
US

IV. Provider business mailing address

2132 SW 36TH ST
REDMOND OR
97756-7958
US

V. Phone/Fax

Practice location:
  • Phone: 541-553-2478
  • Fax:
Mailing address:
  • Phone: 541-771-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR37422
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: