Healthcare Provider Details

I. General information

NPI: 1790264943
Provider Name (Legal Business Name): ELENA CARLOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA CARLOCK RN

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

25503 THISTLEWAITE LN
SPRING TX
77373-3165
US

V. Phone/Fax

Practice location:
  • Phone: 936-249-2244
  • Fax:
Mailing address:
  • Phone: 915-490-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number235221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: