Healthcare Provider Details

I. General information

NPI: 1548974058
Provider Name (Legal Business Name): JACQUELYN ELMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN PREVITY RN

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA ST
PITTSBURGH PA
15213-2543
US

IV. Provider business mailing address

123 BOOTHBAY HBR
BRADFORDWOODS PA
15015-1301
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0794
  • Fax:
Mailing address:
  • Phone: 724-992-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN729156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: