Healthcare Provider Details

I. General information

NPI: 1679783054
Provider Name (Legal Business Name): ROXANNA R ELLIOTT-RENO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNA R ELLIOTT R.N.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E A ST
CASPER WY
82601-2214
US

IV. Provider business mailing address

PO BOX 436
UPTON WY
82730-0436
US

V. Phone/Fax

Practice location:
  • Phone: 866-784-2329
  • Fax:
Mailing address:
  • Phone: 307-689-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR029543
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number18885
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number7755
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: