Healthcare Provider Details

I. General information

NPI: 1528693405
Provider Name (Legal Business Name): ELSIE E NLERUM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 BRIDGEBAY LN
KATY TX
77449-3895
US

IV. Provider business mailing address

3907 BRIDGEBAY LN
KATY TX
77449-3895
US

V. Phone/Fax

Practice location:
  • Phone: 832-887-4652
  • Fax:
Mailing address:
  • Phone: 832-887-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAP143579
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP143579
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: