Healthcare Provider Details

I. General information

NPI: 1174592505
Provider Name (Legal Business Name): ELIZABETH ALICE ELMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 FRANCIS CREEK RD
TWO RIVERS WI
54241-9128
US

IV. Provider business mailing address

4119 MENASHA AVE
MANITOWOC WI
54220-1145
US

V. Phone/Fax

Practice location:
  • Phone: 920-686-0752
  • Fax:
Mailing address:
  • Phone: 920-684-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: